Lectia 1 romana.ppt

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Trecere în Revistă și Trecere în Revistă și Principiile Reanimării Principiile Reanimării Conţinutul lecţiei: Conţinutul lecţiei: Schimb Schimb ă ă ri fiziologice la na ri fiziologice la na ş ş tere tere Diagrama Diagrama de flux a reanimării de flux a reanimării Factori de risc pentru r Factori de risc pentru r eanimare eanimare Echipament şi personal necesare Echipament şi personal necesare Importan Importan ţ ţ a comunic a comunic ă ă rii rii ş ş i a i a muncii în echip muncii în echip ă ă p. 1
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Transcript of Lectia 1 romana.ppt

  • Programul de Reanimare Neonatal. Kit de Slide-uriAcademia American de Pediatrie nu este responsabil de nici una din modificrile aduse acestui program de Echipa de Training in Reanimarea Neonatal a Latter-day Saints Charities. Acest program, modificat astfel, nu poate fi distribuit n Statele UniteLecia 1: TRECERE N REVIST I PRINCIPIILE REANIMRII

  • Trecere n Revist i Principiile ReanimriiConinutul leciei:Schimbri fiziologice la natereDiagrama de flux a reanimriiFactori de risc pentru reanimareEchipament i personal necesare Importana comunicrii i a muncii n echip p. 1

  • Care nou-nscui au nevoie de reanimare?Majoritatea nou-nscuilor sunt viguroi Doar n jur de 10% din nou-nscui au nevoie de oarecare asisten Doar 1% au nevoie de msuri majore de reanimare (intubaie, masaj cardiac i/sau medicaie) pentru a supravieui

    p. 2

    Welfare - Talking Point: Top of page 2 (birth asphexia 23% = 1 million stillbirths... 38% decrease)

  • Fiziologie fetalLa ftAlveolele pulmonare sunt pline cu lichid pulmonarIn utero, ftul este dependent de placent pentru schimburile de gaze

    p. 4

    Welfare - Show video instead of slide

  • Fiziologie fetalLa ftArteriole pulmonare contractateFlux sanguin pulmonar diminuatFlux sanguin deviat prin canalul arterial

    Facei click pe imagine pentru videop. 5

  • Plmnii i Circulaia Dup NaterePlmnii expansionai cu aerLichidul pulmonar fetal prsete alveolele

    Facei click pe imagine pentru videop. 5

  • Plmnii i CirculaiaArteriole pulmonare dilatateFluxul sanguin pulmonar cretep. 5

  • Plmnii i CirculaiaNivelele sanguine de oxigen crescCanalul arterial se contractSngele circul prin plmni pentru a prelua oxigenul

    Facei click pe imagine pentru videop. 6

  • Tranziia NormalUrmtoarele schimbri majore au loc n interval de cteva secunde dup natere:p. 6

    Lichidul pulmonar absorbit; aerul intr n plmniVasele sanguine pulmonare se dilatCrete fluxul sanguin pulmonarArterele i vena ombilical prezint vasoconstricie, crescnd astfel tensiunea arterial

    Welfare - Possible deletion

  • Ce Poate Merge Anormal n Timpul TranziieiVentilaie neadecvat; oxigenul poate s nu ajung n circulaia pulmonar Hipotensiune sistemic de la pierderea excesiv de snge sau hipoxie i ischemie neonatal Arteriolele pulmonare pot rmne n vasoconstricie dup natere (HTPP)Lipsa de perfuzie i oxigenare poate cauza leziuni cerebrale sau deces

    p. 7

    Welfare - Possible Deletion

  • Semne ale Unui Nou-Nscut CompromisDepresia centrilor respiratoriTonus muscular sczut BradicardieTahipneeCianoza persistentHipotensiune

    Tonus bun i cianozHipoton cu cianoz p. 8

  • Compromitere PerinatalApneea primar Privare de oxigenPerioad de tentative de respiraie rapidApneea primar frecven cardiac n scdereSe amelioreaz cu stimularea tactil

    p. 8

  • Apneea secundarContinuarea privrii de oxigen produce apneea secundarFrecvena cardiac i tensiunea arterial scadApneea secundar nu este rezolvat prin stimulare Trebuie administrat ventilaie asistat

    Facei click pe imagine pentru videop. 9

  • Reanimarea Unui Nou-Nscut cu Apnee Secundar

    Apneea secundar prelungit va ntrzia apariia respiraiilor spontaneMasajul cardiac i medicaia pot fi necesare

    Iniierea ventilaiei eficiente cu presiune pozitiv n timpul apneei secundare conduce, de obicei, la mbuntirea rapid a frecvenei cardiace.p. 9

  • Diagrama de Flux a Reanimrii

    Toi nou-nscuii necesit evaluare iniial

    Punei trei ntrebri: Sarcina la termen? Respir sau ip? Tonus muscular bun?Dac da, acordai ngrijire de rutin, cu mama

    p. 10

  • Cale Aerian (Bloc A)Asigurai cldur Poziionai capul i eliberai cile aeriene dac e necesar*tergei tegumentele, stimulai pentru a respira, repoziionai capul pentru a deschide calea aerian*Luai n considerare intubaia traheal n acest moment pentru nou-nscuii cu depresie i lichid amniotic meconial

    p. 10-11Pai iniiali

  • Evaluare

    Frecvenei cardiace: sub 100 bpmRespiraiilor: gasping ori apneeRespiraii laborioase sau cianoz persistentDac datrecei la Respiraie (Blocul B)

    Dup aceti pai iniiali, urmtoarele aciuni se bazeaz pe evaluareaAvei aproximativ 30 secunde pentru a obine un rspuns nainte de a trece la urmtorul

    p. 11

  • Respiraia (Block B - Breathing) n caz de apnee sau FC< 100 bpm:Administrai Ventilaie cu presiune pozitiv*In caz de detres respiratrie:Eliberai calea aerianAdministrai CPAPAtaai un pulsoximetru (daceste disponibil) i administrai oxigen suplimentar dup cum este necesar

    *Luai n considerare intubaia traheal n acest punct

    p. 11

  • Circulaia (Bloc C)

    Administrai masaj cardiac n timp ce continuai ventilaia asistat * Continuai masajul cardiac timp de 45-60 secundeEvaluai din nou

    *Intubaia traheal este recomandat ferm n acest momentDac frecvena cardiac este

  • Medicaia (Block D - Drugs)

    Administrai adrenalin n timp ce continuai ventilaia asistat i masajul cardiac*

    Dac frecvena cardiac este

  • Diagrama de Flux a Reanimriip.12

  • Puncte Importante n Diagrama de Flux a Reanimrii NeonataleFrecvena cardiac 60 bpm Masajul cardiac poate fi opritFrecvena cardiac >100 bpm i respir ventilaia cu presiune pozitiv poate fi opritAsterisc (*): intubaia traheal poate fi luat n considerare n diferite momenteCronologie: dac nu sunt ameliorri dup 30 de secunde, trecei la pasul urmtor (45-60 secunde dup nceperea masajului cardiac)p.13-14

  • Pregtirea Pentru Reanimare:Personal i EchipamentO persoan responsabil de copil la fiecare natereTrebuie s fie capabil s nceap reanimareaCineva disponibil imediat pentru reanimare complet Dac reanimarea este anticipat, trebuie s fie prezent personal suplimentarPregtii echipamentul necesarPornii masa radiant Verificai echipamentul de reanimare

    p.15

  • Pregtirea Pentru Reanimare: Factori de Riscp.16Factori antepartum: Diabet matern Hipertensiune Hemoragii Infecie matern Malarie, HIV, etc. Rupere prematur a membranelor Sarcina multipl Altele

    Factori intrapartum : Natere instrumental Prezentaie pelvian Travaliu prematur Corioamniotit Meconiu Circular sau prolabare de cordon Distocia umerilor Hemoragie semnificativ Altele

  • Fii pregtii s ReanimaiFii ntotdeauna pregtii! Factorii de risc antepartum i intrapartum vor ajuta la identificarea unora dintre nou- nscuii cu riscUnii copii care au nevoie de reanimare nu au niciun factor de riscp.16

  • De Ce Au Prematurii Risc Mai Mare?Posibil deficit de surfactantDrive respirator diminuatMusculatura slab dezvoltat face dificil respiraia spontanPierdere rapid de cldur, control prost al temperaturiiPosibil infecieSusceptibili pentru hemoragie cerebralSusceptibili pentru hipovolemie de la pierderea de sngeesuturile imature pot fi lezate de oxigenul n excesp.17

  • Lucrul Eficient n Echip Comunicarea eficient i coordonarea interveniilor este critic pentru succesul reanimrii neonatale Aptitudini comportamentale Lucrul n echip Capacitate de lider Comunicare clarp.18

  • Dup Reanimare ngrijire de RutinNou-nscuii care rspund la paii iniialiObservare atent pe pieptul mameiNu se recomand aspiraiangrijire Post-reanimare:Nou-nscuii cu depresie respiratorie i necesar de O2Monitorizare frecvent a pacientului i a semnelor vitaleRisc mare de complicaii n perioada de tranziieSe transfer n TIN sau Secia de ngrijiri Specialep.20

  • Sfritul Leciei 1

    *In Lesson 1 you will learn theChanges in physiology that occur when a baby is bornSequence of steps to follow during resuscitationRisk factors that can help predict which babies will require resuscitationEquipment and personnel needed to resuscitate a newborn

    *Which babies require resuscitation?Most newly born babies are vigorous.About 10% of newborns require some assistance to begin breathing at birth.Only about 1% need extensive resuscitation measures (intubation, chest compressions, and/or medications) to survive.

    Instructor Tip: Practice resuscitation skills frequently, especially if skills are not used often. This may be done with mock codes. *In the fetus, oxygen is transferred across the placenta, and the lungs contain no air.

    The alveoli (potential air sacs) of the fetus are filled with fluid that has been produced within the lungs.

    *Blood flow through the fetal lung is markedly diminished compared with that required after birth, as the pulmonary arterioles are constricted and blood flow is diverted across the ductus arteriosus.*At birth, as the newborn takes the first few breaths, several changes occur, whereby the lungs take over the lifelong function of respiration.

    Following birth, the lungs expand as they are filled with air. The fetal lung fluid gradually leaves the alveoli.

    *At the same time as the lungs are expanding and the fetal lung fluid is clearing, the arterioles in the lungs begin to open, allowing a considerable increase in the amount of blood flowing through the lungs.

    *As blood levels of oxygen rise, the ductus arteriosus begins to constrict.

    Blood previously diverted through the ductus arteriosus flows through the lungs, where it picks up oxygen for transport to tissues throughout the body. The ductus remains constricted, and the normal extrauterine circulatory pattern is established.

    *Normally, there are 3 major changes that take place within seconds after birth.

    Alveolar fluid is absorbed into lung tissue and replaced by air. Umbilical arteries and veins are clamped, removing the low resistance placental circuit and increasing systemic blood pressure. Blood vessels in lung tissue relax, increasing pulmonary blood flow.*A baby may encounter difficulty before labor, during labor, or after birth. Some of the problems that may disrupt normal transition areThe baby may not breathe sufficiently to force fluid from the alveoli, or foreign material such as meconium may prevent air from entering the alveoli. Excessive blood loss may occur, or there may be inadequate cardiac contractility or bradycardia from hypoxia and ischemia.Lack of oxygen or ventilation of the newborns lungs results in sustained constriction of the pulmonary arterioles, preventing arterial blood from becoming oxygenated. Prolonged lack of adequate perfusion and oxygenation to the babys organs can lead to brain damage, damage to other organs, or death.

    *The compromised baby may exhibit one or more of the following clinical findings:Poor muscle toneDepression of respiratory drive due to insufficient oxygen reaching the brainBradycardiaLow blood pressureTachypnea (rapid respirations)Cyanosis (blue color)Other conditions, such as infection, hypoglycemia, or depressant drugs given to the mother before birth, may also cause these symptoms.

    *When babies are deprived of oxygen (in utero or after delivery), they undergo a well-defined sequence of events that starts with cessation of respiration.

    Primary apnea follows the sequence noted on this slide. An important point is that, during primary apnea, the newborn responds to stimulation.

    Instructor Tip: Initiate resuscitation immediately. Resuscitation may be inappropriately delayed if the health care provider does not recognize the need for neonatal resuscitation. Any delay in transferring a compromised newborn to the resuscitation team is unacceptable practice. *If oxygen deprivation continues, deep gasping respirations develop, the heart rate continues to decrease, and the blood pressure decreases.

    An important point is that, during secondary apnea, stimulation will not restart the babys breathing. Assisted ventilation must be provided to reverse the process triggered by oxygen deprivation. If a baby doesnt begin to breathe immediately after being stimulated, he or she is likely in secondary apnea and will require positive-pressure ventilation.

    Instructor Tip: Quickly achieve and maintain oxygenation in full-term and post-term newborns after perinatal hypoxia-ischemia because they are especially prone to persistent pulmonary hypertension.

    *Most babies in secondary apnea will respond to effective ventilation with a rapid improvement in heart rate. The longer a baby has been in secondary apnea, the longer it will take for spontaneous breathing to resume. If heart rate does not improve rapidly with effective ventilation, myocardial function may be compromised and chest compressions and/or medications may be required.*The flow diagram begins with the birth of the baby. Each resuscitation step is shown in a block. Below each block is a decision point to help decide whether proceeding to the next step is needed.

    At the time of birth, you should ask yourself 4 questions about the newborn. These questions are shown in the Assessment block. Term gestation?Amniotic fluid clear?Breathing or crying?Good muscle tone?

    If any answer is no, you should continue to the next steps.*These are the initial steps you take to establish an airway and begin resuscitating a newborn. An asterisk (*) indicates intubation may be considered or required (eg, in a depressed newborn with meconium).*After initial steps, evaluate the newborn often, about every 30 seconds.

    If the newborn is not breathing (has apnea) or has a heart rate less than 100 beats per minute (bpm), proceed to Block B.

    Instructor Tip: Respirations and color are naturally assessed during the initial steps because you are handling the baby and assessing progress through the first moments of transition. *If the newborn is not breathing adequately (has apnea or is gasping), has a heart rate of