Download Free Medical Neonatal resuscitation-NNR PowerPoint Presentation

Neonatal resuscitation-NNR PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical titled "Neonatal resuscitation (NNR)" by Dr. Renu Singh.

This medical talks about Neonatal resuscitation (NNR), the medical intervention given to a newborn baby who is not breathing or is breathing poorly at birth. It involves a series of steps aimed at helping the baby breathe on their own and maintain adequate oxygen levels in the body. NNR is a critical aspect of newborn care, as failure to initiate timely resuscitation can lead to serious complications and even death.

The steps involved in NNR depend on the severity of the babys condition, but generally include clearing the airway, providing oxygen, and providing chest compressions if necessary. The healthcare provider will also assess the babys heart rate, color, and muscle tone to determine the appropriate level of intervention.

NNR is typically performed by trained healthcare professionals, including obstetricians, midwives, and neonatal nurses. It is important that healthcare providers who attend deliveries have the necessary skills and equipment to provide NNR when needed. Regular training and review of NNR skills and protocols can help ensure that healthcare providers are prepared to respond appropriately in emergency situations.

Tags : Neonatal resuscitation, Emergency Medicine, Emergency Medicine

Published on : Apr 14, 2023 | Views : 1422 | Downloads : 1

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Neonatal resuscitation (NNR) Dr. Renu Singh
Slide 2-

Burden of the problem Birth asphyxia 23% of the 1 million neonatal deaths in India Long term neurological complications Death NNR (Neonatal resuscitation) :simple, inexpensive, cost effective method Problem: NNR often not initiated, incorrect use of methods
Slide 3-

Successful NNR: factors Anticipation: call a skilled personnel Adequate preparation Accurate evaluation, algorithm based Prompt initiation of support
Slide 4-

1.Anticipation: High risk delivery Maternal condition Advanced maternal age ,DM, HT, stillbirth, fetal loss, early neonatal death Fetal condition Prematurity, post maturity, congenital anomalies, multiple gestations Ante partum complications: APH, oligo /polyhydramnios Delivery complications Malpresentation, MSAF, instrumental delivery, antenatal asphyxia with abnormal FHR
Slide 5-

2. Adequate preparation Radiant warmer is turned on,& is heating Oxygen source is open with adequate flow through the tubing Suction apparatus tested, functioning properly Laryngoscope is functional with bright light Resuscitation bag & mask demonstrates an adequate seal & generation of pressure
Slide 6-

Radiant warmer
Slide 7-

ppt slide no 7 content not found
Slide 8-

ppt slide no 8 content not found
Slide 9-

ppt slide no 9 content not found
Slide 10-

ppt slide no 10 content not found
Slide 11-

Successful NNR: factors Anticipation: call a skilled personnel Adequate preparation Accurate evaluation, algorithm based Prompt initiation of support
Slide 12-

Evaluation, algorithm based Rapid assessment of neonate clinical status Is the infant full term? Is the infant breathing or crying? Does the infant has good muscle tone? Yes: no resuscitation, routine neonatal care No: needs resuscitation
Slide 13-

ppt slide no 13 content not found
Slide 14-

Approach to resuscitation2010 AHA, AAP A: initial steps(provide warmth, clear airway if necessary, dry, stimulate) B: breathing(ventilation) C: chest compressions (circulation) D: administration of drugs &/or volume expansion
Slide 15-

Resuscitation: initial steps Provide warmth Head position “ sniffing position” Clearing the airway, if necessary Drying the baby Tactile stimulation for breathing
Slide 16-

ppt slide no 16 content not found
Slide 17-

AAP Algorithm
Slide 18-

AAP Algorithm
Slide 19-

ppt slide no 19 content not found
Slide 20-

PPV: Positive pressure ventilation Form of assisted ventilation Needed when there is no improvement in HR Also assess chest wall movements Should be delivered at rate of 40-60 breaths /min, maintain HR>100 /min Devices: BMV, ET (endotracheal tube),LMA(laryngeal mask airway)
Slide 21-

ppt slide no 21 content not found
Slide 22-

Bag & mask ventilation
Slide 23-

ppt slide no 23 content not found
Slide 24-

Endotracheal tube If BMV is ineffective/prolonged When chest compressions are performed Initial endotracheal suctioning of non vigorous meconium stained newborn
Slide 25-

Endotracheal tube
Slide 26-

ppt slide no 26 content not found
Slide 27-

LMA(Laryngeal mask airway) Soft mask, fits over laryngeal inlet when inflated, occludes the oesophageal opening Done when BMV is unsuccessful & tracheal intubation is unsuccessful or not feasible
Slide 28-

LMA(Laryngeal mask airway)
Slide 29-

Targeted SPO2 after birth
Slide 30-

Initial steps in resuscitation PPV
Slide 31-

AAP Algorithm
Slide 32-

Chest compressions Started when HR<60 per minute despite adequate ventilation with 100% oxygen for 30 sec Delivered at lower third of sternum, to depth 1/3 of AP diameter of chest 2 techniques: 2 thumb-encircling hands technique Compression with 2 fingers ,second hand supporting the back 3:1 ratio::[ 90 comp:30 ventilations]
Slide 33-

ppt slide no 33 content not found
Slide 34-

ppt slide no 34 content not found
Slide 35-

Initial steps of resuscitation PPV(ET) CHEST COMPRESSIONS
Slide 36-

ppt slide no 36 content not found
Slide 37-

AAP Algorithm
Slide 38-

Medications Rarely indicated Most important step to treat bradycardia is establishing adequate ventilation HR remains <60bpm,despite adequate ventilation(ET) with 100% Oxygen & chest compressions Epinephrine or volume expansion or both
Slide 39-

Epinephrine Route of administration: intravenous(IV),ideal Recommended dose: 0.01-0.03 mg/kg per dose Desired concentration: 1:10,000 0.1 mg/ml
Slide 40-

Volume expansion Suspected or known blood loss Isotonic crystalloid solution ; normal saline Blood Dose calculation: 10 ml/kg
Slide 41-

ppt slide no 41 content not found
Slide 42-

The golden minute <30 seconds: complete initial steps Warmth Drying Clear airway if necessary Stimulate 30-60 seconds: assess 2 vital characteristics Respiration (apnea/gasping/labored/unlabored) Heart rate (<100/>100bpm) Golden Minute Project: skill based training
Slide 43-

ppt slide no 43 content not found
Slide 44-

AAP Algorithm
Slide 45-

Post resuscitation care Needed for those who required PPV At risk of deterioration Hypo/hyperthermia ,hypoglycemia, CNS complications(apnea, HIE), pulmonary complications(TTN, Pneumonia), hypotension Need monitoring ,evaluation NICU may be necessary
Slide 46-

NNR : not indicated Conditions with certainly early death Extreme prematurity(GA<23 weeks) Birth weight<400g Anencephaly Chromosomal abnormality: Trisomy 13
Slide 47-

NNR: nearly always indicated High rate of survival Acceptable morbidity GA≥ 25 weeks Those with most congenital malformations
Slide 48-

NNR? Conditions associated with uncertain prognosis Survival borderline Parental desires concerning initiation of resuscitation should be supported
Slide 49-

Discontinuing resuscitative efforts Newborn with no detectable heart rate, consider stopping NNR if the heart rate remains undetectable for 10 minutes
Slide 50-

Summary Most infants transfer from intrauterine to extra uterine life 10% need some intervention,1% need extensive resuscitation Anticipate the need for NNR Adequate preparation for NNR Evaluate the newborn as per AHA/AAP guidelines & follow the recommended protocol
Slide 51-

MCQ1 For successful neonatal resuscitation following is/are needed except: Anticipation Adequate preparation Skilled personnel Delayed initiation of support
Slide 52-

MCQ1 For successful neonatal resuscitation following is/are needed except: Anticipation Adequate preparation Skilled personnel Delayed initiation of support
Slide 53-

MCQ2 Following are true in relation to initial steps of neonatal resuscitation except Provide warmth Tactile stimulation Endotracheal intubation Drying the baby
Slide 54-

MCQ2 Following are true in relation to initial steps of neonatal resuscitation except Provide warmth Tactile stimulation Endotracheal intubation Drying the baby
Slide 55-

MCQ3 The following is the primary measure of adequate ventilation Chest wall movement Improvement in heart rate Pink extremities Spo2 of 100%
Slide 56-

MCQ3 The following is the primary measure of adequate ventilation Chest wall movement Improvement in heart rate Pink extremities Spo2 of 100%
Slide 57-

MCQ4 Endotracheal intubation may be indicated at several points during neonatal resuscitation except Ineffective BMV During chest compressions Vigorous meconium stained newborn Non vigorous meconium stained newborn
Slide 58-

MCQ4 Endotracheal intubation may be indicated at several points during neonatal resuscitation except Ineffective BMV During chest compressions Vigorous meconium stained newborn Non vigorous meconium stained newborn
Slide 59-

MCQ5 The recommended compression to ventilation ratio in neonatal resuscitation is 2:1 3:1 4:1 5:1
Slide 60-

MCQ5 The recommended compression to ventilation ratio in neonatal resuscitation is 2:1 3:1 4:1 5:1
Slide 61-

MCQ6 The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation 0.01-0.03,IV 0.01-0.03,IM 0.03-0.05,1V 0.05-0.1,IV
Slide 62-

MCQ6 The recommended dose(mg/kg per dose) and route of epinephrine in neonatal resuscitation is 0.01-0.03,IV 0.01-0.03,IM 0.03-0.05,1V 0.05-0.1,IV
Slide 63-

MCQ7 Recommended method/clinical indicator of confirming ET placement is Condensation in ET Chest movement Equal breath sounds on auscultation Exhaled C02 Detection
Slide 64-

MCQ7 Recommended method/clinical indicator of confirming ET placement is Condensation in ET Chest movement Equal breath sounds on auscultation Exhaled C02 Detection