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..
NICU here. I see this situation almost every week at work. Difference is we get a much quicker heads up due to monitors. I would say it's safe to call a 6 day old infant a candidate for NRP versus PALS. ANON 456 had it pretty much down. I would use wall suction over bulb any day if available but bulbs are great to start.
I would elaborate that I would give suction/stimulate, possibly PPV should be given half a chance before starting compressions. Almost all neonatal cardiac brady/arrest will improve with restored respiratory status. I've witnessed literally thousands of apnea/bradycardia events and only a tiny percentage have ever required compressions.
With the NICU infants I don't call for help unless I've had to pull out the PPV. But If I was in the regular mother baby floor I'd probably call a code immediately.
TiffyRN, BSN, PhD
2,316 Posts
NICU here. I see this situation almost every week at work. Difference is we get a much quicker heads up due to monitors. I would say it's safe to call a 6 day old infant a candidate for NRP versus PALS. ANON 456 had it pretty much down. I would use wall suction over bulb any day if available but bulbs are great to start.
I would elaborate that I would give suction/stimulate, possibly PPV should be given half a chance before starting compressions. Almost all neonatal cardiac brady/arrest will improve with restored respiratory status. I've witnessed literally thousands of apnea/bradycardia events and only a tiny percentage have ever required compressions.
With the NICU infants I don't call for help unless I've had to pull out the PPV. But If I was in the regular mother baby floor I'd probably call a code immediately.