transport or increased care: you decide
TRANSCRIPT
© The Children's Mercy Hospital, 2014. 03/14
Dr. Steven Olsen, MD, FAAPRegional Neonatal Conference:
Decision Making and Optimal Care and OutcomesApril 9, 2015
Transport or Increased Care: You Decide
© The Children's Mercy Hospital, 2014. 03/142
What is your specialty?
A. Mother-Baby nurse
B. NICU nurse
C. NNP
D. Physician
E. Other
Moth
er-Baby nurse
NICU nurse
NNP
Physician
Other
0% 0% 0%0%0%
© The Children's Mercy Hospital, 2014. 03/143
In which setting do you work?
A. Newborn nursery
B. Special Care nursery
C. Level II NICU
D. Level III NICU
E. Other
Newborn nurse
ry
Specia
l Care
nursery
Leve
l II N
ICU
Leve
l III N
ICU
Other
0% 0% 0%0%0%
© The Children's Mercy Hospital, 2014. 03/14
Baby AInfant born at 37 weeks to a G1P0 mother after a long labor
complicated by a tight nuchal cord. Sent to NICU for observation. Infant is pale, CR 4 sec, RR 75, minimal intercostal retractions, Sats 96%, mean BP 40. ABG
7.20/30/85/-15
A. Transport Out
B. Increase Care
C. Continue to Observe
Transport
Out
Increase
Care
Continue to O
bserve
0% 0%0%
© The Children's Mercy Hospital, 2014. 03/14
Baby B
A. Transport
B. Increase Care
Transport
Increase
Care
0%0%
39 week infant delivered by repeat C/S to a mother with GDM. Infant with grunting respirations, moderate subcostal retractions, Sats 94% under 50% oxyhood. ABG 7.22/60/52/-2.
© The Children's Mercy Hospital, 2014. 03/14
A. Respiratory Distress Syndrome
B. Persistent Pulmonary Hypertension
C. Transient Tachypnea of the Newborn
D. Hypoglycemia 0% 0%0%0%
Baby B cont’d.What is your diagnosis?
© The Children's Mercy Hospital, 2014. 03/14
Baby C
A. Transfer
B. Increase Care
0%0%
Infant born 30 minutes ago at 30 weeks GA, BW 1400 grams. Temp 97.5, HR 140, Sat 97%, CR 3 sec. Just intubated, on 30% oxygen. CXR c/w RDS. Umbilical lines placed. ABG 7.22/60/68/-4. Mean BP from UAC 24.
© The Children's Mercy Hospital, 2014. 03/14
Baby C cont’d.
A. Normal Saline bolus
B. Increase ventilator support
C. Surfactant
Normal S
aline bolus
Increase
ventilator s
upport
Surfa
ctant
0% 0%0%
If you opt to increase care, what would be your first plan?
© The Children's Mercy Hospital, 2014. 03/14
Baby D
A. Transfer
B. Increase Care
Transfer
Increase
Care
0%0%
37 week male delivered vaginally. Mother UDS +Meth, no prenatal care, bloody fluid noted at delivery. Infant being
observed. Temp 35, RR 60, mean BP 35. After about 2 hours of age, had a 10mL emesis which was dark green-brownish.
© The Children's Mercy Hospital, 2014. 03/14
Baby D cont.
A. Temp
B. History
C. BP
D. Emesis
E. Other
Temp
History BP
EmesisOther
0% 0% 0%0%0%
Which concerns you the most about this baby?
© The Children's Mercy Hospital, 2014. 03/14
Baby E
A. Prepare for discharge
B. Increase care
Prepare fo
r disc
harge
Increase
care
0%0%
35 week infant, DOL 3, has been in well newborn nursery. Mother reports BF fine. Diapers past 24 hours: 3 wets, 1
stool. Discharge assessment – T 36.5, sleepy but arouses, some jaundice.
© The Children's Mercy Hospital, 2014. 03/14
Baby E cont.
A. Warming infant
B. Checking blood sugar
C. Checking bilirubin
D. Lactation consultation
E. Discharge order being written
Warm
ing infant
Checking blood su
gar
Checking bilir
ubin
Lacta
tion consu
ltation
Discharge
order being w
r...
0% 0% 0%0%0%
You decide to call the physician. What is your highest priority?
