Resuscitation

Revival after apparent death

Risk factor for the need of resuscitation:

In neonate:
Twin gestation
Prematurity
Presence of meconium
In child:
Accidents or illnesses that compromise the
respiration
Presentation: depends on the situation that leads
to resuscitation
Compromise of respiration system, cardiac
system or both
Physical examination:
Cyanotic, pale or mottled appearance
Drooling, if foreign body aspiration
Apnea
Tachycardia, bradycardia or asystole
“Apnea is defined as a respiratory pause lasting more
than 20 seconds—or any pause accompanied by
cyanosis and bradycardia”
Heart rate
Diagnostic tests: vary according to the presentation;
Apgar score needs to be determined
Treatment: “A, B, C”
A: Airway
B: Breathing
C: Circulation
In neonate:
Position, suction and tactile stimulation
Oxygen
Bag valve ventilation
Chest compression
Intubation (tube size 2.5 – 3.5, no cuff)
Medication
Steps in the Resuscitation
1)Dry the infant well, and place him or her under the radiant heat
source

2) Gently suction the mouth, then the nose

3) Quickly assess the infant's condition

The best criteria are the infant's respiratory effort (apneic, gasping
or, regular) and heart rate (> 100 or < 100 beats/min)

A depressed heart rate—indicative of hypoxic myocardial

depression—is the single most reliable indicator of the need for
resuscitation.
4) Infants who are breathing and have heart rates over 100
beats/min usually require no further intervention
Infants with heart rates less than 100 beats/min and apnea or
irregular respiratory efforts should be stimulated vigorously
The baby's back should be rubbed with a towel while oxygen is
provided near the baby's face

5) If the baby fails to respond to tactile stimulation within a few

seconds, begin bag and mask ventilation.
Adequacy of ventilation is assessed by observing expansion of the
infant's chest accompanied by an improvement in heart rate,
perfusion, and color
The rate of bagging should be 40–60 breaths/min.
6) If no respond to bag and mask ventilation, intubation is
appropriate.
Failure to respond to intubation and ventilation can result from
(1) mechanical difficulties
(2) profound asphyxia with myocardial depression, and
(3) inadequate circulating blood volume.

7) If mechanical causes are ruled out and the heart rate remains
below 60 beats/min after intubation and PPV for 30 seconds,
cardiac compression should be initiated.
8) If drugs are needed,
epinephrine 1:10,000 solution, 0.1–0.3 mL/kg given via
the endotracheal tube or preferably through an umbilical
venous line.

Sodium bicarbonate, 1–2 mEq/kg of the neonatal dilution

(0.5 mEq/mL), can be used in prolonged resuscitation
efforts in which the response to other measures is poor

If volume loss is suspected, 10 mL/kg of a volume

expander (normal saline) should be administered
through an umbilical vein line.
In children,
Secure airway
100% Oxygen
Start intravenous or intraosseous route of

administration
Check vital signs
If severe cardiorespiratory compromise, follow

standard algorithms
Intubation (cuffed endotracheal tube if children >8
In aspiration of foreign body that is obstructing
flow of air to the lungs-
Children older than 1 year
Heimlich maneuver:
Wrapping the examiner’s arm around the
victim’s waist from behind
Placing a fist on the abdomen between the
rib cage and navel
Administering upward abdominal thrusts
Maneuver should be performed until the foreign
body dislodges
Children older than 1 year:
Heimlich maneuver
Children younger than 1 year
No Heimlich maneuver
No any blind finger sweeps
Perform back blows and chest thrusts

Complications:
Morbidity and mortality from attempts of
resuscitation
Children younger than 1 year
Children younger than 1 year