Prolonged Hypoxemia due to inadequate oxygenation, ventilation and circulation and cardiac arrest/resuscitation.
Cardiac arrest and prolonged hypoxic children.
Cardio pulmonary resuscitation is a basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac compressions.
Staff Nurse, Auxillary Nurse Midwife, NICU Registrar, Head Nurse and Consultants.
- Keep the following equipments ready –
- Ambu bag with face mask and oxygen connection.
- Intubation tray containing small size endotracheal tube, laryngoscope with appropriate size blade, stellate, Dynaplast and lubrication jelly.
- Crash Cart.
- Ventilator with ventilator tubing.
- Keep central suction ready with sterile suction catheter.
- Two 100 ml Normal Saline for suction.
- Radiant warmer, stethoscope.
- Emergency drug like Inj. Adrenaline, Inj. Atropine, Inj. Soda-bi-carbonate.
- Disinfectant for hand rubs.
- Kidney tray.
- Assess child for airway, breathing and circulation.
- Establish airway by lifting the child’s chin or jaw should be displaced forward to maintain airway patency.
- The neck should be extended slightly.
- If airway is not patent intubation provides airway patency.
- If respiratory arrest has occurred, ventilation must be provided using bag and mask with 100% oxygen.
- A nasogastric tube should be introduced to relieve abdominal distension due to bag and mask ventilation.
- The child should be well oxygenated before intubation.
- Monitor heart rate throughout the procedure.
- Bag and mask ventilation should be provided if the child becomes cyanotic or bradycardic.
- Assist for intubation.
- Once tube is passed, hand ventilation is performed while chest expansion is assessed and breath sounds are auscultated.
- If clinical examination indicates satisfactory tube position, secure the tube with tape in such a way that the centimeter marking is visible at the child’s lips.
- Attach Endo Tracheal Tube to mechanical ventilation.
- Cardiac compression should be provided whenever cardiac arrest occurs.
- The rescuer must compress the sternum directly over the heart.
- Chest compressions are performed one finger width below the nipple line in the infant at the rate of 100/min. Compressions performed are finger width above the coastal sternal junction of a child at a rate of 100/min.
- The child should be placed on a rigid cardiac board during compression.
- Vascular access should be achieved quickly during CPR.
- Same resuscitation drugs like adrenaline, atropine may be administered endotracheal.
- Fluid or Blood products should be administered to the children who are in hypovolemic shock.
- If spontaneous cardiac activity does not return within 30 minutes of resuscitation, it is reasonable for the team to consider cessation of resuscitation.
- After the resuscitation, make the child comfortable.
- Remove all the used articles, wash them and restock the crash cart.
- Generated Biomedical waste should be segregated as per HIC policy.
- Documents in Nurse’s Observation Sheet whether –
- Resuscitation was successful.
- Condition of a Child.
- Duration of resuscitation.
- The level of E.T. Tube should be recorded or an adhesive tape be placed at the head end of the bed.
- The size and the marking of E.T. tube to be placed at the head end of the bed.
- Observe for any hypothermia, acidosis or other complications.
- Drugs used and the outcome.