So though neonatal resuscitation is not necessarily part of the normal BLS program, we think it's
important that, for those of you who have an infant that's less than a month old, or
for those of you who actually work with neonates, that you have an understanding of the differentiation
between baby or infant CPR and neonatal resuscitation. So we're going to highlight some of the aspects
of both the single and the two-rescuer CPR for the neonate. So we understand that a neonate
is a baby that not necessarily falls into the category of premature, but is newborn
up to 30 days. We're also going to understand that this baby, if they are in trouble, is
in most cases going to be in trouble because of respiratory drive or a lack of oxygen,
versus cardiac-driven cardiac arrest. So a lot of what you're going to see here is respiratory-driven
respiratory response. And you'll see that reflected in how we give rescue breaths, but
also in how we do CPR for a neonate that we do not suspect had cardiac arrest, and then
that's why they're unresponsive. Now keep in mind that the rescue mask is very small.
It's going to be important that you have it be the size appropriate for the neonate. They
actually do have smaller face shields for preemies, and so it's important that if you're
in a clinical setting, that you have the appropriate size equipment for the appropriate size patient.
Now as we try to elicit a response from this baby, we find that they're not breathing normally,
they're cyanotic, and they're not responsive. If we've not already called a code or called
for 911 or EMS, we're now going to call for EMS. "You in the plaid shirt, go call 911,
come back. I might need your help. And if you can find an AED bring it with you." If
you're in a clinical setting, call a code and bring the cardiac resuscitation team in.
Now I'm going to be checking for a brachial pulse for no more than 10 seconds. Now this
baby in this situation has a pulse rate that is less than 100 beats per minute, but not
less than 60. In this case I'm going to begin rescue breathing at a rate of 1 breath every
3 seconds. How much air do we put in, you say? Enough to get chest rise and fall. So
1 breath every 3 seconds. We're going to do this for 2 minutes. After 2 minutes I reassess
for a brachial pulse, and now the brachial pulse is less than 60 beats per minute. I'm
now going to go into neonatal resuscitation, which is going to be 3 chest compressions
followed by 1 rescue breath, then followed by 3 more compressions and 1 rescue breath.
And we keep that 3:1 ratio going for another 2 minutes. Landmarks are still the same, imaginary
line across the nipples, 2 fingers down on the sternum. We're going to be compressing
at the depth of 1/3 the chest of the baby, and we're going to be compressing no less
than 100 times per minute, up to 120 times per minute. We're going to do this 3:1 for
2 minutes, reassess for a brachial pulse. If there is still a slow pulse, or no pulse,
we're going to continue CPR, 3 compressions, 1 rescue breath, until EMS arrives, until
the baby revives, or until an AED arrives. Now let's discuss the difference between single
rescuer and two rescuer neonatal resuscitation. Now again, remember, there's a bit of a difference
in how we resuscitate if we believe that the unresponsive neonate is due to a cardiac-related
situation that led them to this versus a respiratory-driven problem. If it's respiratory-driven arrest,
or bradycardia, meaning slow pulse, we're going to be doing 3 compressions to 1 rescue
breath. If we believe though that there's a congenital heart defect or there was a cardiac
arrest that led to their unresponsiveness and no breathing, we're going to do 15 compressions
to 2 rescue breaths. So just a special note to keep in mind there. But when I have a second
rescuer, this works extremely well, and it's usually going to be found more in a clinical
or a professional healthcare provider related scenario. So with the second rescuer, we can
incorporate things like high flow oxygen with bag valve mask, and we can also incorporate
the circumferential thumb compression, which allows for a lot of efficiency when it comes
to 3 compressions and 1 rescue breath. We're still going to do the setup the same way.
We're still going to activate a code or EMS, but when we deliver the CPR, you'll see how
we orchestrate two-rescuer into this. So we check for the baby's responsiveness and normal
breathing. They are not breathing normally and they're not responding to my taps and
shouts. I'm now going to activate EMS or call a code, and now we're going to assess the
baby for a brachial pulse for no more than 10 seconds. If at that time I feel a pulse
of 100 or less, but not less than 60, the rescue breather is going to give 1 rescue
breath every 3 seconds. >> speaker 2: Breathe. >> speaker 1: 1 1000, 2 1000, 3 1000. >> speaker
2: Breathe. >> speaker 1: After 2 minutes of rescue breathing we're going to reassess
a brachial pulse. If at that time the pulse rate is less than 60, we are now going to
incorporate full neonatal CPR with 3 compressions followed by a rescue breath. 3 compressions,
rescue breath. We're going to continue to do that until the patient begins to respond
or an AED arrives. If the AED arrives, we're going to stop only to put the pads on, and
then we'll move into the actual defibrillation mode. But we're going to continue to do this
resuscitative effort until either the baby starts breathing normally or the next level
of care comes to take over.