- correction of hypoxia (most common cause of neonatal arrest)
- decreased risk of meconium aspiration
- support circulation
- Declare emergency
- Call for help (neonatal/paediatric registrar or consultant)
- Move baby to resuscitare
- Stimulate baby by drying
- open airway and assess for patency (suction if required)
- if this baby doesn’t respond quickly will probably need intubation (appropriate size for term neonate = 3.5, intubate and place tip of ETT just beyond cords – ensure adequately ventilating both lungs, length @ lips should be 9cm)
- if meconium soiling airway intubate and suction down ETT before ventilating
- administer 100% O2 via bag-mask (5 effective breaths)
- provide PEEP
- watch for spontaneous breathing
- if no respiratory effort give IPPV until HR >100
- pulse = 60/min -> institute chest compression (3:1) @ rate of 100/min with thumbs around chest
- begin to obtain IV access by placing an IV cannula into the umbilical vein or interossous needle insertion
- administer adrenaline (0.1mL/kg o 1:10,000 – the average full term neonate = 3.5kg thus administer 0.35mL IV or 3.5mL into trachea)
- give an IV normal saline bolus of 70mL (20mL/kg)
- attach ECG if not responding ? shockable rhythm
- send bloods for cord pH and ABG
- check glucose (dextrose 10% 5mL/kg)
- consider naloxone 200mcg IM
- consider NaHCO3 4.2% 1mmol/kg = 3.5mmoL
EXPOSURE/ ENVIRONMENT/ EVERYTHING ELSE
- keep warm and dry
- make sure wet towels are removed quickly and replaced with warm ones
- Constantly reassess airway, breathing, circulation, disability and exposure
- Transfer to neonatal unit for ongoing assessment and treatment
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.