ECS23-Donofrio--Pediatric and Neonatal Arrest Updates: What’s Age Got to Do With It?

Introduction

The speaker, Dr. Joel Dinofrio Odman, is introduced as an assistant professor of Pediatrics and emergency medicine at the University of California San Diego. She specializes in pre-hospital care and research focused on out-of-hospital cardiac arrest in pediatrics.

Neonatal Resuscitation

This section covers the resuscitation of a newly delivered infant.

Equipment Preparation

• Have equipment ready such as warmers, hats, blankets, suctions, and airway access.

• Call for help from an email team or RN and RT if needed.

Assessing the Baby's Condition

• Determine if the baby is relatively full-term, looks like a normal baby, crying with good tone. If yes to all three questions, bring the baby to mom for skin-to-skin contact and breastfeeding.

• If the baby doesn't have good tone or isn't crying vigorously stimulate them to breathe.

Breathing Assessment

• Check heart rate and breathing. If not breathing well assess perfusion time since every minute of poor perfusion leads to about five minutes of needing help before they start breathing on their own.

Conclusion

The speaker concludes by summarizing key points covered in neonatal resuscitation.

Neonatal Resuscitation

This section covers the steps to take when resuscitating a newborn baby.

Steps for Resuscitation

• Warm, dry, and stimulate the baby to breathe.

• Check the heart rate. If it's slow, bag the baby and throw on a monitor for continuous feedback.

• Correct ventilation if needed. If heart rate is still low after 30 seconds of bagging, start chest compressions.

• Administer medications if necessary (epinephrine or saline).

• Focus on resuscitation first before checking Apgar score at one minute.

Breathing and Oxygenation

• Start with room air and give positive pressure to pop lungs open.

• Increase oxygen concentration gradually if needed (30% then 100%).

• LMA can be used for great oxygenation and ventilation in this age group.

Equipment Needed

• Ensure that neonatal equipment such as LMA, laryngoscope blade, and CO2 monitor are available in emergency departments.

Temperature Management for Newborns

In this section, the speaker discusses how to manage the temperature of newborn babies, including preemies and those born outside of a hospital setting.

Preparing for Temperature Management

• Have double blankets ready to keep the baby warm.

• Use a wet blanket to stimulate and dry the baby, then wrap them in a dry blanket to maintain warmth.

• Use a polyurethane bag to reduce heat loss significantly. Pull it up to their armpits but avoid covering their airway or neck.

Therapeutic Hypothermia

• Therapeutic hypothermia is used for certain babies who need cooling.

• The optimal cut-off time for therapeutic hypothermia is within 6 hours if you're 36 weeks gestation or above.

• Early transport may be necessary if there's a risk of hypoxic ischemic encephalopathy.

Resuscitating Newly Delivered Babies

In this section, the speaker discusses how to resuscitate newly delivered babies and what medications are needed.

Medications Needed

• Epi, saline, and blood glucose are all that's needed when resuscitating newly delivered babies.

• Umbilical venous catheterization can be done if there's enough time. Otherwise, use an intraosseous needle unit (IO).

Resuscitation Process

• If the baby is breathing on their own with a good heart rate due to blow-by, warm them up and monitor their heart rate.

• If the heart rate is slow or they're apnic despite rescue breaths, do compressions for 30 seconds before reassessing.

• If the heart rate is still slow, give epi and consider blood saline.

Transitioning to Air Environment

In this section, the speaker discusses how to transition a newborn baby to their air environment.

Monitoring Breathing and Heart Rate

• The only things that need to be monitored are the baby's breathing and heart rate.

• Once the baby starts breathing on their own with a heart rate over 60 or 100, respectively, they no longer need rescue breaths or compressions.

• Newly delivered babies are a high-risk population that requires special attention.

Resuscitation of Newly Delivered

This section discusses the importance of resuscitating a newly delivered baby and its connection to the mother's health.

Importance of Resuscitation

• Resuscitation of a newly delivered baby is important.

• Complications with both mom and baby should be addressed together.

• Keeping mom and baby together is crucial.

Case Study: 12-Year-Old Male with Cardiac Arrest

This section presents a case study of a 12-year-old male who experienced cardiac arrest while surfing at the beach.

Case Study

• A 12-year-old male had cardiac arrest while surfing at the beach.

• Lifeguards performed CPR, placed an Opa, and used an AED to shock him twice.

• EMS defibrillated him after finding him in v-fib. He received compressions, one dose Epi, and was admitted to Pediatric ICU.

• He was treated as a trauma patient due to epistaxis from wave crash injury.

Use of AED Data for Diagnosis

This section discusses how AED data can be used for diagnosis in emergency situations.

Use of AED Data

• Project Heartbeat captures all deployed AED data in their city.

• The speaker received a call about an interesting case where an AED showed croissants on a 12-year-old boy who had cardiac arrest while surfing.

• The boy was diagnosed with catecholamine polymorphic vtac from a genetic mutation.

• Early diagnosis and treatment led to the patient's neurologically intact survival.

Pediatric Cardiac Arrest

This section discusses how to handle pediatric cardiac arrest situations.

Handling Pediatric Cardiac Arrest

• Use the same skills for pediatric cardiac arrest as for adults.

• High-quality compressions, adequate ventilation, and early defibrillation work for kids too.

• Focus on early access and know your sites of IO.

Pediatric Cardiac Arrest Care

In this section, the speaker discusses pediatric cardiac arrest care and highlights the importance of administering Epi within five minutes. The speaker also talks about airway management and emphasizes that intubation should be held off until after achieving ROSC.

Epi Administration and Airway Management

• First dose Epi is associated with frost survival to discharge and survival to neuro-intact status.

• In pediatric cardiac arrest, intubation can wait until after achieving ROSC.

• Bag thrown LMA in you want to make sure you have good oxygenation ventilation and perfusion but you don't have to worry about the tube until you actually hit rosk.

• Secure tube secure head to keep everything in place and don't be afraid to use a pediatric app there are many different types of apps that are successful for showing you what kind of dosing you need what kind of tube you need.

Post-ROSC Care

• Targeted normothermia is recommended for post-ROSC care.

• Prevent hypotension, hypoxia, and hyper/hypocapnia in order to improve outcomes for adults and kids brain trauma and cardiac arrest.

• There are five pre-rest conditions that one should be aware of: septic shock, hemorrhagic shock, opioids, persistent pulmonary hypertension, and cardiac etiology.

• Consider ECMO early if dealing with critically ill patients.

Neonatal Resuscitation

In this section, the speaker discusses neonatal resuscitation during obstetrical emergencies and highlights the importance of breathing and heart rate.

Neonatal Resuscitation

• Resuscitation of the newly delivered is all about breathing and heart rate.

• High-quality cardiac arrest care should be provided to help transition from the liquid to the air-based environment.

• Thank you message.