I have a priority nursing question?

[s1992]

Hey all, I have a quick question to ask you.

1.) A 6 day old who is vomiting all feeds and is found cyanotic with emesis in his mouth upon entering the room. What would you do?

As part of your care team you can use a charge nurse, CNA, resp. therapist, child life therapist, social worker, unit secretary, also available is one RN and LPN, NOT ALL IS USED.

It seems like such a simple question but im making it more out to be than what it is..

1. Assess the situation/infant (appears cyanotic)

2. Check for airway patency(Idk if you would take the time to listen to the lungs at this moment) ((find out that emesis is obstructing breathing))

3. (Heres were my order is bad) ... Call for assistance from LPN/RN, ask them to inform the charge nurse on the situation (call a code), (would they then call respiratory?)

4. Due to complete obstruction would you then administer infant CPR? try to "finger" out the emesis in the mouth then position the infant for back blows followed by chest thrusts? If baby was to be unconscious then go to two rescue breaths, if the chest doesn't rise then do 30 compressions. Re assess the baby for patency?

I'm not really sure to be honest this order although I should. Your going to want to get the obstruction out first of course. If you couldnt get the emesis out with fingers then due chest thrusts/back blows.. reassess airway and still if nothing maintain compressions/breaths??

If anyone has any advice I'd really appreciate it..

Thanks everyone.

[Coffee Nurse, BSN, RN]

If the baby is blue, he's probably not breathing, and quite possibly in cardiac arrest secondary to respiratory arrest. I'd maybe do a fast check to see if he was breathing, but would be calling that code right quick -- better to apologize to people for a false alarm than trying to manage an arrested baby without enough personnel. Why is an MD not available for your "care team"?

Bear in mind that it's a 6-day-old, so the feed/emesis is going to be milk or formula. Unless you have suction readily to hand, removing the obstruction (if there even is one) is going to be difficult. Get out what emesis you can, fast, then start with rescue breathing. If your initial breaths don't go in, reposition the airway and try again. Don't start compressions until you're sure you've managed to ventilate, otherwise you've got no oxygen to move around with compressions (baby is already cyanotic).

[s1992]

see below

[s1992]

duh.. sorry lol ive been at work all day thanks for jogging my memory. A bulb suction would be ideal at that particular moment, which that could take place of the "finger" out part. I'm new to peds so bare with me lol

[s1992]

I'm not to sure why an "MD" isn't an option. It was a worksheet handed out to all of us students. Your 100% right, thanks a lot for your response.

[dudette10, MSN, RN]

Look up PALS. That should help you with prioritization.

[KelRN215, BSN, RN]

In real life, working suction should be present at the bedside of all pediatric patients. I'd hit the code light and begin suctioning the baby then everyone else would be in the room within about 6 seconds and we'd crack the code card/pull the ambu bag off the wall and start resuscitation.

You don't need a Child Life Specialist to deal with the code but if this is a double room, she can go console the roommate. The Social Worker can take the parents out of the room and deal with them while the medical team works.

[madwife2002, BSN, RN]

Moved to Student assistance forum

[RNNPICU, BSN, RN]

Pt is blue, remember it is now CAB, circulation, airway, breathing. Try fo 10 secs feel for a pulse, begin CPR if weak or undetectable. Yell for help. Seconds count!

[Mavrick, BSN, RN]

Pt is blue, remember it is now CAB, circulation, airway, breathing. Try fo 10 secs feel for a pulse, begin CPR if weak or undetectable. Yell for help. Seconds count!

Isn't CAB just for adults who are much more likely to have heart disease?

With kids doesn't the respiratory system fail before cardiovascular?

C'mon NICU nurses help us out here

[Mavrick, BSN, RN]

This article leads me to believe that ventilation is a priority. But I would like to know what PALS advocates.

Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

[Coffee Nurse, BSN, RN]

Isn't CAB just for adults who are much more likely to have heart disease?

With kids doesn't the respiratory system fail before cardiovascular?

C'mon NICU nurses help us out here

PALS still says CAB for pediatric cardiac arrest, but I think the NRP guidelines are more applicable here, especially since you have a big hint (emesis around the mouth) that the problem is respiratory in origin. Plus, like I said before, I'm not sure how useful compressions are going to be if you already have cyanosis present. Maybe my NICU bias is showing, but I'd want to get that kid ventilated first.