Neonatal Emergencies Flashcards
Umbilical IV access
Indications for umbilical vein:
> emergency vascular access
> central venous monitoring
> exchange transfusion
> central Venus Access
Indications for umbilical artery:
> measurement of arterial blood gases
> arterial blood pressure monitoring
> angiography
> Resuscitation
* Umbilical vein is best during resuscitation*
Contraindications for both umbilical arterial and Venus access:
> Omphalocele
> gastroschisis
> omphalitis
> peritonitis
> vascular compromise
> necrotizing enterocolitis
Umbilical anatomy
> two smaller arteries
one large vein
Umbilical artery cath(UAC) complications
> thrombosis
embolism
vasospasm
loss of an extremity
hypertension
air embolism
necrotizing Enterocolitis
infection
bladder injury
vessel, perforation
factory hypoglycemia
peritoneal perforation
sciatic nerve palsy
Umbilical vein cath (UVC) complications
> infection
thromboembolism
perforation of peritoneum
portal hypertension
digital ischemia
Pneumopericardium
pericardial effusion and tamponade
cardiac arrhythmias
Anatomy differences in infants
> rib cage is more elastic/flexible
lungs are small and delicate
Mediastinum is more mobile
bones are softer(great force required to break)
liver/spleen are larger and more vascular
fontanelle are present
anterior Fontanelle closes @ 12-18months posterior @ 2months
Blood pressure in peds
> 90+(2xage)= normal systolic BP
70+(2xage)=hypotension
gestational age in weeks= neonate MAP
Peds ETT sizes (also NGT, OGT, suction)
> age in weeks move the decimal to the left 1 spot example: 25wk = 2.5mm ETT
greater than 1yr: (age +16)/4
double the size of ETT for NGT, OGT, Foley, suction.
quadruple ETT size for chest tube. Also works for adult chest tube sizing.
Normal blood volume in peds
> 75 to 80 mL/kg of blood
25% loss can cause shock symptoms
Cardiac output in peds
> Normal is 4–8 L/Min
HR is the quickest way to increase Q
diastolic filling is everything = 2/3 MAP
SV is the amount of blood ejected during systolic phase
ejection fraction = 50–70%(60-135mL)
SV is made up of 3 things( preload, afterload, contractility)
ST vs SVT in peds
> 220-age = sinus tachycardia
S/S of and unstable tachycardia: decreased LOC, respiratory failure, hypotension
assess fever and try fluids before cardioversion
Bradycardia in peds
> peds decompensate FAST
assess respirations and fix right away
Start compressions with rate <60
Pericarditis(older peds)
> viral or bacterial in nature
sharp chest pain
easily localized by patient
radiates to the base of the neck
unable to lay supine
global STE without reciprocal changes
downsloping P – R interval
Hypoglycemia in peds
Treat if sugar is < 40
Peds fluid calculation formula
*Always use D10 or D5 in NS because they burn through there sugar fast
> 0-10kg— 4mL/kg = mL/hr
> 10-20kg— 2mL/kg(+40mL above)=mL/hr
> 20kg— 1mL/kg(+60mL above)=mL/hr
Fluid maintenance neonates
> 60-80mL/kg/day—D10 - <28weeks
100mL/kg/day—D10 - >28weeks
Glucose Infusion Rate(GIR)
> 6-8mg/kg/day
> don’t exceed D12
> goal is to increase rate and or adjust percent of dextrose not exceed D12
Environmental stimuli considerations
> over stimulus promotes HTN
HTN causes bleeds
keep environment as quiet and as dark as possible, simulate mothers womb.
gentle handling/loading
keep environment warm!
Neonatal distress
> rule out common causes like hypoglycemia or environmental stimulus
seizures are very subtle in neonates
seizure examples are as follows: repetitive mouth/tongue movement, bicycle kicks, eye deviation/blinking