Entertain me''

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Entertain me..

• WAYNEs ABCs
• Always Be Cool
• BE CALM DONT LOOSE YOUR COOL

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Newborn, Infant, Pediatric..

• Respiratory-Cardio Assessment
• Quick Patient Assessment
• Describe anatomical difference
• They are not small adults
• The importance of history

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Anatomic and Physiologic Differences

• Upper Airway greater risk for occlusion
• Tongue Larger
• Epiglottis larger
• Larynx Higher in relation to spine
• Nasal passages narrow
• Narrow airways
• Narrow lower airways

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Anatomic and Physiologic Differences

• Low Reserves
• Heart is proportionately large within cage
• Thoracic cage soft
• Abdominal cavity large
• Obligate nose breathers
• High metabolism rate (gtoxygen demand)
• 100 cal/kg vs- 50 cal/kg adult

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Anatomic and Physiologic Differences

• Other factors
• Skin surface area to body weight
• Prone to heat loss and water loss
• Delicate fluid balance

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History of the Neonate

• Pregnancy
• Obstetric
• GRAVITA pregnancy / PARA live births
• Exposure
• Drugs
• Amniotic fluid
• Polyhydramnios
• Oligohydramnios
• Gestational Age

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History of the Neonate

• Gestational Age
• _at_ conception
• Term 40 weeks
• 36 weeks lungs mature
• Dubowitz Assessment
• Ballard Assessment

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History of the Neonate

• Labor Delivery
• Presentation
• Fetal heart rate
• Variability, bradycardia, tachycardia,
  acceleration, deceleration
• Premature
• APGAR Score

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APGAR Score
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Newborn, Infant, Pediatric..

• Respiratory-Cardio Assessment
• Quick Patient Assessment
• Recognize signs of resp. distress, resp failure
  and shock
• Equipment description, use and limitation
• Oxygen delivery
• Airway Management

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Quick Patient Assessment

• Recognize
• Respiratory distress
• Respiratory failure
• Shock
• Resp. Failure Shock
• Cardiopulmonary Failure
• Cardiopulmonary Arrest

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Quick Patient Assessment

• Resp. Failure Shock Cardiopulmonary Failure
• Cardiopulmonary Arrest

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Newborn, Infant, Pediatric..

• Quick (From The Door) Patient Assessment
• Initial Assessment
• Stable or Unstable (SHOCK)
• General Appearance looks good vs looks bad
• Call for HELP!
• Work of Breathing
• Airway Maintenance
• Normal-self maintained
• Needs Assistance
• Artificial
• History
• Family
• Trauma / non-trauma
• Acute illness
• Chronic illness

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Newborn, Infant, Pediatric..

• Patient Assessment
• Respiratory Assessment
• Pattern
• Br Sound
• Inspiratory
• Expiratory
• Sputum
• Work of Breathing
• Environment
• Any one else sick
• Home

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Newborn, Infant, Pediatric..

• Age Appropriate behavior
• Crying but consolable
• Response to pain
• Arousable
• Inappropriate behavior
• Inconsolable
• Lack of pain response
• Comatose
• Compensated Vital Signs
• Initially increases HR and RR
• Grunting
• Nasal Flaring
• Very Limited Reserves
• Arrhythmia Bradycardia

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Newborn, Infant, Pediatric..

• Vital signs
• Heart rate - normal
• Newborn-Infant 85-200
• Child 60-170
• Abnormal
• Consider Supraventricular Tachycardia (SVT)
• Above 220 bpm for newborn/infant
• Above 180 bpm for child
• Blood Pressure Minimum systolic
• 0 to 1 month 60 mmHg
• gt1month to 1yr 70 mmHg
• 1 to 10yrs 70 mmHg (2 x age in yrs)
• gt10yrs 90 mmHg
• Capillary refill
• lt2 sec

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Newborn, Infant, Pediatric..

• Vital signs
• Respiratory Rate
• Premature infant 40-90/min
• Newborn (term) 30-50
• Child (2-12yrs) 20-30
• Adult 12-20
• Abnormal
• Grunting
• Agonal
• Paradoxical
• Retraction
• Nasal Flaring

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Newborn, Infant, Pediatric..1

• Vital signs
• Very Limited Reserves
• Tachypnea to Apnea
• Tachycardia to Bradycardia

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Cardio-Pulmonary Evaluation

• Newborn, Infant, Pediatric
• Causes for V/Q mismatch
• Respiratory Assessment
• Cardio/Perfusion Assessment

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GOAL Avoid Respiratory Failure2

• Breathing Assessment
• Rate
• Chest movement
• abdominal
• paradoxical
• Breath sound
• Upper airway sounds
• Aeration
• clear / absent
• O2 start

• Pump / Circuit Assessment
• Heart rate
• Pulse pressure
• Capillary refill time
• Tactile temperature
• Signs of dehydration
• Signs of trauma
• Blood pressure
• Thermal reg
• IV access

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EQUIPMENT

• Partial - Rebreathing masks
• Venti-masks
• Cannulas
• Conventional
• High Flow Vapotherm
• Trach collars
• Hood
• Humidifiers
• Cool Mist
• Heated

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EQUIPMENT

• SVN
• Lowflow nebs
• continuous aerosols
• Inline with ventilators
• Highflow nebs cont aerosols for large patients
• SPAG
• Aerochambers mouthpiece / mask

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Emergency EQUIPMENT AIRWAY

• Partial - Rebreathing masks
• Nasopharyngeal Airways
• Oral Airways
• Suction kits
• ETTs
• Stylet
• ETT securing tape
• Liquid Adhesive
• SVN w/ inline adapter

• Laryngoscope Blade
• Self-Inflating Bag
• O2 Reservoir
• Pressure gauge nipple
• Peep Valve
• Masks
• Flow-Inflating Bag
• Manometer and gas
• HME / Artificial Nose
• Misc Adapters
• 15,22 mm
• Tubing connectors
• Mec Asp. Adapter

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INTUBATION EQUIPMENTNewborn

• Blade size 0-1straight(st)
• Wt (kg) ETT (mm) Depth (cm)

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Infant - Small Child INTUBATION EQUIPMENT
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Child - Large Child INTUBATION EQUIPMENT

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ETT size depth formula

• Size Age in years 4
• 4
• Depth Tube ID(mm) X 3

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Steps to Intubation

• Monitors
• Cardio/Resp
• Pulse Oximeter
• ETCO2 or Detector
• Set-up Test Equipment
• Vacuum and suction supplies
• Laryngoscope and blade - include one larger
• ETT-include a smaller second tube
• Securing tape
• Self - Inflating Resuscitator
• Mask (if doing BVMa lot easier with 2 people)
• Call for team member
• Waynes A B C

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Steps to Intubation . . .

• Preoxygenation BVM, blow-by O2
• Sedation
• Paralysis
• Cricoid pressure
• Intubation
• Assessment of intubation
• Bilateral Chest rise and fall
• Tube condensation
• 3 point auscultation of chest
• Monitor SaO2 and ETCO2
• Secure ETT (note depth at lips)
• Confirmation of intubation
• CXR

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Respiratory Assisting

• Optimal goal Strive on Synchrony
• KNOW YOUR EQUIPMENT
• Maximize ventilation
• MAXiMiZE TEAMWORK

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• Its nice to be important, but
• its more important to be nice.
• - Arnold Palmer

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• POSITIVE PRESSURE VENTILATION
• Things that I need to observe
• Chest Excursion
• Perfusion
• Patient movement
• Feeling the compliance
• Secretions
• When verifying results
• Auscultate patients chest then abdomen
• Apply CO2 Sensor or EtCO2 post intubation
• Palpate patients pulse rate / perfusion
• Check patient SaO2

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• POSITIVE PRESSURE VENTILATION
• Things that I need consider
• Excessive leak around TT
• Peep
• Adequate O2 flow
• Too much VT or rate air trapping
• or PEEP impaired cardiac output
• Sudden deterioration
• DOPE

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wheres the vent !!!

• settings???

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heres the vent !

• Infant/Child
• Rate 20,30
• vt 5-8/kg (watch chest)
• Peep 4
• FiO2 1.0
• Adj. per Blood Gas

• Newborn/Infant
• Rate 30,40
• I.T. 0.5s
• PIP 20 (watch chest)
• Peep 4
• FiO2 1.0
• Adj. per Blood Gas