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

Nov 2007Nov 2007 ACoRN © 2005-07ACoRN © 2005-07

Admission of a BabyAdmission of a Baby


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.


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

GestatioGestational Age nal Age < 28 w< 28 w


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

Oxygen administrationOxygen administration


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?


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?



• 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?



• 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.



• 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


• 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



• 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 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?


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?


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?


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?


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?


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?


Questions??Questions??

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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