Nrp Essay

D-3: Neonatal Resuscitation
A woman who is 40 weeks pregnant presents to the Emergency Department in labor. She is G4 P3 and has had prenatal care throughout her pregnancy. Upon exam, the infant is crowning and delivery is imminent.
General code outline

1. As newborn is presenting, the cord is found to be wrapped around its neck. The physician unwinds the cord before the delivery of the patient. Infant is delivered by physician and has poor tone, minimal respiratory effort and central cyanosis. The cord is cut by the physician and the patient is placed in the infant warmer. Other staff are assigned to care for the mother.

The newborn is floppy with occasional gasping breaths. Resuscitation supplies are gathered by the staff. The patient is dried and stimulated and placed in the sniffing position to open the airway. The APGAR score is determined to be 3.

3. The patient is reassessed and found to have only occasional gasping respirations with a heart rate of 90. Skin color is cyanotic with poor muscle tone. Positive pressure ventilation with bag-valve-mask should be initiated utilizing room air. This should continue for a full 30 seconds. Re-evaluate the APGAR and ABCs.

4. The patient is having minimal shallow respirations with a heart rate of 50. Skin is cyanotic. Chest compressions should be initiated and positive pressure ventilation should continue with the BVM on 100% oxygen while preparing to intubate patient.

5. Reassess after intubation and verify placement. Lung sounds are equal bilaterally with good rise and fall of the chest. Heart rate is 50. Continue chest compressions and prepare to medicate with epinephrine after umbilical vein is accessed. If an umbilical vein is unable to be accessed, consider administering the medication via IV/IO/ETT.

6. Ventilation via ET tube continues and the heart rate responds to epinephrine and oxygenation. Heart rate is now in the 130s. Color is improving.

7. Prepare for transfer to NICU or...