nov 2007 acorn © 2005-07 admission of a baby. nov 2007 acorn © 2005-07 case mom is 32 yr old g2...

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Admission of a BabyAdmission of a Baby

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CaseCase

• Mom is 32 yr old G2 P1, 34 wks by dates Mom is 32 yr old G2 P1, 34 wks by dates • Admitted to hospital with abdominal pain and Hgb Admitted to hospital with abdominal pain and Hgb

of 88g/L of 88g/L • Onset of labour is spontaneous - she delivers a Onset of labour is spontaneous - she delivers a

baby boy vaginally 2 hours later baby boy vaginally 2 hours later • Apgar 6 and 7Apgar 6 and 7• The baby quickly develops marked work of The baby quickly develops marked work of

breathing with severe indrawing - oxygen is breathing with severe indrawing - oxygen is required to maintain his colour. required to maintain his colour.

• He is transferred to the nursery with oxygen to the He is transferred to the nursery with oxygen to the face.face.

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““Wet-in-bag” resuscitationWet-in-bag” resuscitation

GestatioGestational Age nal Age < 28 w< 28 w

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• How would you usually administer How would you usually administer oxygen during resuscitation and oxygen during resuscitation and transfer?transfer?

Oxygen administrationOxygen administration

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Case (cont’d)Case (cont’d)• In the nursery, In the nursery, you quickly you quickly

weigh the baby before weigh the baby before positioning him on a positioning him on a radiant warmer.radiant warmer.

• Birth weight is 1900 gms.Birth weight is 1900 gms.

• How would you keep the How would you keep the baby warm and baby warm and comfortable on the scale?comfortable on the scale?

• How would you keep the How would you keep the baby pink while weighing?baby pink while weighing?

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Case (cont’d)Case (cont’d)

• You transfer the baby to a You transfer the baby to a radiant warmer.radiant warmer.

• To what do you set the To what do you set the temperature and mode?temperature and mode?

• Where and how do you Where and how do you secure the skin probe?secure the skin probe?

• What are causes of over-What are causes of over-heating and under-heating heating and under-heating the baby?the baby?

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Case (cont’d)Case (cont’d)

• OROR .. You transfer the .. You transfer the baby into a warmed baby into a warmed humidified incubator humidified incubator with ambient Owith ambient O22

• What temperature and What temperature and mode would you set mode would you set the incubator to? the incubator to?

• What role does What role does humidity play?humidity play?

• What are causes of What are causes of over- and under-heating over- and under-heating a baby in an incubator?a baby in an incubator?

• How would you position How would you position the baby?the baby?

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Case (cont’d)Case (cont’d)

• While positioning the baby, you reassess While positioning the baby, you reassess breathing, heart rate and colour as per breathing, heart rate and colour as per NRP guidelines.NRP guidelines.

• Because he is breathing, HR > 100 and Because he is breathing, HR > 100 and colour is pink with administration of colour is pink with administration of oxygen, you do an ACoRN Primary oxygen, you do an ACoRN Primary Survey.Survey.

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Case (cont’d)Case (cont’d)

• The Primary Survey shows:The Primary Survey shows:– laboured respirations, moderate indrawing, laboured respirations, moderate indrawing,

RR 45/min, decreased breath sounds, RR 45/min, decreased breath sounds, grunting with stimulationgrunting with stimulation

– OO22 sats 94%: receiving 55% O sats 94%: receiving 55% O22 in a head box in a head box

– HR 140/min, BP 40/24 mean 30, capillary refill HR 140/min, BP 40/24 mean 30, capillary refill >3 sec>3 sec

– colour pale pink colour pale pink – tone appears somewhat floppytone appears somewhat floppy

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• How would you usually administer How would you usually administer oxygen during stabilization?oxygen during stabilization?

• Oxygen hoodOxygen hood

• Into incubatorInto incubator

• Nasal prongsNasal prongs

Oxygen administrationOxygen administration

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• How do you best How do you best control the inspired control the inspired oxygen oxygen concentration? concentration?

• How would you track How would you track the amount of the amount of oxygen being oxygen being administered?administered?

Oxygen administrationOxygen administration

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Oxygen analyzerOxygen analyzer

• How do you How do you calibrate the calibrate the analyzer? analyzer?

• How often do you How often do you calibrate the calibrate the analyzer?analyzer?

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Cardiorespiratory monitoringCardiorespiratory monitoring

• Where do you apply the leads?Where do you apply the leads?

• How do you secure the leads?How do you secure the leads?

• What should you set the alarm settings to?What should you set the alarm settings to?

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BP measurementBP measurement

• What does the BP reflect?What does the BP reflect?

• What values are you What values are you looking for?looking for?

• How do you select the How do you select the appropriate size cuff? appropriate size cuff?

• Where do you apply the Where do you apply the cuff?cuff?

• What are causes of What are causes of incorrect results?incorrect results?

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Pulse oximeter monitoringPulse oximeter monitoring

• Where do you apply the Where do you apply the probe?probe?

• How do you secure the How do you secure the probe?probe?

• What are causes of incorrect What are causes of incorrect results?results?

• What should you set the What should you set the pulse oximeter alarm pulse oximeter alarm settings to?settings to?

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Blood glucose samplingBlood glucose sampling

• How would you obtain How would you obtain a blood sample from a blood sample from this baby for glucose this baby for glucose screening? screening?

– by lab specimen? by lab specimen?

– by bedside testing by bedside testing device?device?

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Blood glucose sampling (cont’d)Blood glucose sampling (cont’d)

• How would you prep the skin for sampling?How would you prep the skin for sampling?

• How would you grasp the limb during How would you grasp the limb during sampling?sampling?

• What size of lancet would you use?What size of lancet would you use?

• How would you protect the lanced site? How would you protect the lanced site?

• What are the potential complications What are the potential complications caused by capillary sampling?caused by capillary sampling?

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Questions??Questions??