Nutrición en Nonatos
Es para ver el estado del niño en que se encuentra y según eso darle o pasarle la alimentación ya sea oral enteral o parenteral permitiendo proporcionar los nutrientes que el neonato.
Nutrición en Nonatos
Es para ver el estado del niño en que se encuentra y según eso darle o pasarle la alimentación ya sea oral enteral o parenteral permitiendo proporcionar los nutrientes que el neonato.
Recién Nacido con dificultad respiratoria, patologías más frecuente, sindrome de dificultad respiratoria o enfermedad de membrana hialina, taquipnea transitoria del recién nacido y desinforme de aspiración de liquido amniótico meconiado. Basado en la Guía Española del mismo nombre
Reanimación Neonatal: Lección 3 USO DE INSTRUMENTOS DE REANIMACIÓN PARA SUMIN...roogaona
Curso de Reanimación neonatal, lección 3 de 9.
Lección 3: USO DE INSTRUMENTOS DE REANIMACIÓN PARA SUMINISTRAR VENTILACIÓN A PRESIÓN POSITIVA
American Heart Association. American Academy of Pediatrics.
Reanimación Neonatal: Lección 1 PANORAMA GENERAL Y PRINCIPIOS DE LA REANIMA...roogaona
Curso de Reanimación neonatal, lección 1 de 9.
Lección 1: PANORAMA GENERAL Y PRINCIPIOS DE LA REANIMACIÓN
American Heart Association. American Academy of Pediatrics.
Recién Nacido con dificultad respiratoria, patologías más frecuente, sindrome de dificultad respiratoria o enfermedad de membrana hialina, taquipnea transitoria del recién nacido y desinforme de aspiración de liquido amniótico meconiado. Basado en la Guía Española del mismo nombre
Reanimación Neonatal: Lección 3 USO DE INSTRUMENTOS DE REANIMACIÓN PARA SUMIN...roogaona
Curso de Reanimación neonatal, lección 3 de 9.
Lección 3: USO DE INSTRUMENTOS DE REANIMACIÓN PARA SUMINISTRAR VENTILACIÓN A PRESIÓN POSITIVA
American Heart Association. American Academy of Pediatrics.
Reanimación Neonatal: Lección 1 PANORAMA GENERAL Y PRINCIPIOS DE LA REANIMA...roogaona
Curso de Reanimación neonatal, lección 1 de 9.
Lección 1: PANORAMA GENERAL Y PRINCIPIOS DE LA REANIMACIÓN
American Heart Association. American Academy of Pediatrics.
Reanimación Neonatal: Lección 8 REANIMACIÓN DE RECIÉN NACIDOS PREMATUROSroogaona
Curso de Reanimación neonatal, lección 8 de 9.
Lección 8: REANIMACIÓN DE RECIÉN NACIDOS PREMATUROS
American Heart Association. American Academy of Pediatrics.
Masaje Cardíaco.
La reanimación o resucitación cardiopulmonar al nacer es un emergencia mayor en Pediatría. No hay otro período de la vida en que la probabilidad de requerir reanimación sea mayor: Alrededor de un 5 a 10% de los recién nacidos requiere algún grado de reanimación y de 1 a 10% de los nacimientos intrahospitalarios requieren de alguna forma de ventilación asistida . El tratamiento del niño deprimido, que no respira, puede ser fundamental para su sobrevida y calidad de vida. Debe ser realizado con el más alto nivel de competencia, lo que incluye personal calificado, equipamiento y medicamentos. Estas condiciones deben existir en todos los partos.
La principal causa de depresión cardiorespiratoria al nacer es la hipoxia perinatal.
-Pulso
Es una onda que se origina en el corazón y se propaga a través de todas las arterias en el cuerpo. Esto sucede cada vez que el corazón se contrae (o da un latido), y hace circular la sangre por todo el organismo. La onda se percibe como un pulso y se puede palpar o tomar en diferentes partes del cuerpo por donde pasan las diferentes arterias como ocurre en las muñecas y el cuello (ya que, en estos sectores corporales, las arterias se hallan más cerca de la piel).
-IMC
El Índice de masa corporal es una medida que asocia el peso de una persona con su talla o estatura. Es un indicador de la grasa total corporal, la cual se relaciona con el riesgo de enfermedad cardiovascular y con el riesgo de muerte cardiovascular.
En base al IMC podemos tener una idea más precisa, aunque no absoluta, de si tenemos un peso adecuado o si estamos en una categoría de sobrepeso o incluso de obesidad.
-Formula de Karvonen
La fórmula de Karvonen es un método para el cálculo de las pulsaciones a un porcentaje de carga de trabajo determinado. Es un test general muy utilizado a la hora de saber el nivel de entrenamiento para cada persona diseñado para determinar la intensidad del ejercicio para cada persona.
2. Masaje Cardíaco
Contenido:
• Indicaciones para el masaje cardíaco
• Como dar el masaje cardíaco
• Como coordinar el masaje cardíaco con
la ventilación con presión positiva
• Cuando suspender el masaje cardíaco
4-2
3. Masaje Cardíaco
Masaje Cardíaco
• Aumenta temporalmente la circulación
• Debe ser acompañado de ventilación
• Debe usarse oxígeno al 100%
4-3
4. Masaje Cardíaco : Indicaciones
FC menor de 60 a
pesar de ventilación
positiva efectiva
durante 30 segundos
4-4
5. Masaje Cardíaco :
• Comprime el corazón
contra la columna
• Aumenta la presión
intratorácica
• Permite circular la
sangre hacia órganos
vitales incluyendo el
cerebro
Click on the image to play video
4-5
6. Masaje Cardíaco :
Se Requieren 2 Personas
• Una persona
comprime el tórax
• La otra persona
continúa la
ventilación
4-6
7. Comparación De Las Técnicas
De Masaje Cardíaco
• Técnica de los Pulgares (Preferida)
– Menos cansada
– Mejor control de la profundidad de las
compresiones
• Técnica de los 2 Dedos
– Es mejor para manos pequeñas
– Permite el acceso al cordón umbilical para
la administración de medicamentos
4-7
8. Masaje Cardíaco : Colocación de
los Pulgares o Dedos
• Ubique los dedos en la
parte baja de la caja
torácica hasta que
localice la apófisis
xifoides
• Coloque sus dedos o
pulgares sobre el
esternón, arriba del
xifoides sobre la línea
que conecta los
pezones
4-8
9. Masaje Cardíaco : Masaje
Cardíaco
• Los pulgares
comprimen el
esternón
• Los dedos dan
apoyo a la espalda
4-9
10. Masaje Cardíaco :
Técnica de los Pulgares
• Aplique presión solo
sobre el esternón, al
retirar la presión, se
permite que el tórax
se expanda y pueda
darse ventilación
4-10
11. Técnica de los Pulgares
Click on the image to play video
4-11
12. Masaje Cardíaco :
Técnica de los 2 Dedos
• Con las puntas de
los dedos medio e
índice o anular, se
comprime el
esternón
• La otra mano de la
soporte a la espalda
4-12
17. Masaje Cardíaco : Coordinación
Con la Ventilación
Click on the image to play video
4-17
18. Masaje Cardíaco : Coordinación
con la Ventilación
• Un ciclo de 3 compresiones y una
ventilación toma 2 segundos
• La frecuencia respiratoria es de 30
ventilaciones por minuto y el masaje
cardíaco de 90 compresiones por minuto.
Esto es igual a 120 “eventos” por segundo
4-18
19. Masaje Cardíaco :
Suspendiendo el Masaje
Después de 30
segundos de masaje
cardíaco y ventilación
debe detenerse y
medir la frecuencia
cardíaca
4-19
20. Masaje Cardíaco : Si la FC
Permanece por debajo de 60 lpm
• Compruebe que haya una ventilación
adecuada
• Considere intubación endotraqueal si no
se ha hecho ya
• Inserte un catéter umbilical para
administrar adrenalina
4-20
In Lesson 4 you will learn
When to begin chest compressions during a resuscitation
How to administer chest compressions
How to coordinate chest compressions with positive-pressure ventilation
When to stop chest compressions
When a newborn becomes hypoxic, the heart rate slows and myocardial contractility decreases. As a result, there is a diminished flow of blood and oxygen to the vital organs.
The decreased supply of oxygen to these tissues can lead to irreparable damage to the brain, heart, kidneys, and bowel.
Chest compressions are used to temporarily increase circulation and oxygen delivery.
Chest compressions should always be accompanied by ventilation with 100% oxygen.
Ventilation must be performed to ensure that the blood being circulated during chest compressions is oxygenated.
When chest compressions are indicated, the newborn probably has very low blood oxygen levels and significant acidosis. The myocardium is depressed and unable to contract strongly enough to pump blood to the lungs. Chest compressions will mechanically pump blood through the heart while ventilation continues.
Instructor Tip: Even experienced resuscitators are concerned at the point when a baby requires chest compressions. Talk to each other and calmly plan your next steps. Concentrate on the tasks at hand and anticipate the need for additional help to record events, insert an orogastric tube if not already done, prepare for intubation if not already done, prepare for administration of epinephrine, and prepare for establishment of an umbilical venous line.
Chest compressions, sometimes referred to as external cardiac massage, consist of rhythmic compressions of the sternum that
Compress the heart against the spine.
Increase the intrathoracic pressure.
Circulate blood to the vital organs.
The heart lies between the lower third of the sternum and the spine. Compressing the sternum compresses the heart and increases the pressure in the chest, causing blood to be pumped into the arteries.
Two people are required to administer chest compressions—one to compress the chest and one to continue ventilation. These 2 people need to coordinate their activities. The person administering chest compressions must have access to the chest and be able to position his or her hands correctly. The person assisting ventilation will need to be positioned at the newborn’s head to achieve an effective face-mask seal (or to stabilize the endotracheal tube), ventilate appropriately, and watch for effective chest movement.
With the thumb technique, the 2 thumbs are used to depress the sternum while the hands encircle the torso and the fingers support the spine.
With the 2-finger technique, the tips of the middle finger and either the index or ring finger of one hand are used to compress the sternum. The other hand is used to support the newborn’s back so that the heart is more effectively compressed between the sternum and spine. With the second hand supporting the back, you can feel the pressure and depth of compressions.
Instructor Tip: The requirement to put your hand under the newborn’s back also serves to keep you focused on the task at hand, and prevents someone from expecting you to reach for equipment or to do other tasks with your “spare hand.”
Run your fingers along the lower edge of the rib cage until you locate the xyphoid. Place your thumbs or fingers on the sternum, immediately above the xyphoid. Pressure is applied to the lower third of the sternum. Care must be used to avoid applying pressure to the xyphoid, which is a small projection where the lower ribs meet at the midline.
The thumb technique is accomplished by encircling the torso with both hands and placing the thumbs on the sternum and the fingers under the baby’s back, supporting the spine. The thumbs can be placed side by side or, on a small baby, one over the other.
Care must be taken to not squeeze the chest (ribs) with your whole hand during compression. If the chest is squeezed, fractured ribs or a pneumothorax may result.
The thumb technique cannot be used effectively if the newborn is large or your hands are small. However, you may find the thumb technique less tiring than the 2-finger technique if chest compressions are required for a prolonged period.
The thumb technique makes access to the umbilical cord more difficult when intravenous medications become necessary.
Instructor Tip: It’s easy for a nervous resuscitator to inadvertently squeeze the newborn’s chest or to hold on tightly during and between compressions. All members of the team should watch each other’s technique and calmly make suggestions for modification if necessary. Remember that parents may be listening and trying to interpret your comments. Rather than saying, “Jane, you’re squeezing his chest and I can’t ventilate.” It would be better to say, “Jane, loosen your hands a little.”
This is a demonstration of the proper method of the thumb technique for chest compressions.
Position the 2 fingers perpendicular to the chest, as shown, and press vertically with your fingertips.
When compressing the chest, only the 2 fingertips should rest on the chest. This gives the best control of the pressure applied to the sternum.
If you rest other portions of your hand on the chest, you can restrict chest expansion during ventilation and apply pressure to the vulnerable area of the chest, risking a pneumothorax or fractured ribs.
This is a demonstration of the correct method of the 2-finger technique of chest compressions.
Instructor Tip: Notice that the 2 people engaged in providing chest compressions and ventilations cannot perform other tasks. Do not expect them to reach for equipment, engage in lengthy conversation with others, document resuscitation events, or draw up medications.
Controlling the pressure used in compressing the sternum is an important part of the procedure. With your fingers and hands correctly positioned, you should use enough pressure to depress the sternum to a depth of approximately one third of the anterior-posterior diameter of the chest, then completely release the pressure to allow the heart to refill. One compression consists of the downward stroke plus the release. The actual distance compressed will depend on the size of the newborn.
The duration of the downward stroke of the compression should be somewhat shorter than the duration of the release for generation of maximum cardiac output.
Your thumbs or the tips of your fingers should remain in contact with the chest at all times during compression and release. If you take your thumbs or fingers off the sternum after compression, you
Waste time relocating the compression area.
Lose control over the depth of compression.
May compress the wrong area, producing trauma to the chest or underlying organs.
As you perform chest compressions, you must apply enough pressure to compress the heart between the sternum and spine without damaging underlying organs. Potential complications can occur.
The ribs are fragile and can be easily broken.
Pressure over the lower tip of the sternum (xyphoid) can lead to laceration of the liver.
During resuscitation, chest compressions always must be accompanied by positive-pressure ventilation with 100% oxygen. Avoid giving compressions and ventilation simultaneously, because one will decrease the efficacy of the other. Therefore, the 2 activities must be coordinated, with 1 ventilation interposed between every third compression, for a total of 30 breaths and 90 compressions per minute.
The person doing the compressions should take over the counting from the person doing the ventilations. The compressor should count, “One-and-Two-and-Three-and Breathe-and,” while the person ventilating squeezes during “Breathe-and” and releases during “One-and.” Note that exhalation occurs during the downward stroke of the next compression. Counting the cadence will help develop a smooth and well-coordinated procedure.
Instructor Tip: The person ventilating the newborn must be ready to deliver the breath in the moment the compressor says, “Breathe.” Do not allow a long pause to wait for the breath. The pace is rapid and the ventilator must keep up.
During chest compressions, the ventilation rate is actually 30 breaths per minute rather than the rate you previously learned for positive-pressure ventilation without compressions, which was 40 to 60 breaths per minute.
This lower ventilatory rate is necessitated by the need to provide an adequate number of compressions, yet avoid simultaneous compressions and ventilation. To ensure that the process can be coordinated, it is important that you practice with another person and practice both roles.
After approximately 30 seconds of well-coordinated compressions and ventilation, stop for 6 seconds to determine the heart rate again. To determine heart beats per minute, count the beats in 6 seconds and multiply by 10. Announce the actual heart rate (say “the heart rate is 70” not “I count 7 beats”).
If the heart rate is >60 bpm, discontinue chest compressions but continue positive-pressure ventilation at the rate of 40 to 60 breaths per minute
If the heart rate is >100 bpm and the newborn begins to breathe spontaneously, slowly withdraw positive-pressure ventilation and move the newborn to the nursery for post resuscitation care
If the heart rate is <60 bpm, intubate the infant (if not already done), insert an umbilical venous catheter and give epinephrine
Instructor Tip: Learn to assess the heart rate quickly. You should be able to recognize, within a few beats, if the heart rate is less than 60 bpm, 100 bpm, and more than 100 bpm.
When you are administering chest compressions and coordinating ventilation, continue to ask yourself the following questions:
Is chest movement adequate?
Is supplemental oxygen being given?
Is the depth of chest compression approximately one third of the anterior-posterior diameter of the chest?
Are the chest compressions and ventilation being well-coordinated?
If the heart rate remains less than 60 beats per minute, you should give epinephrine, as described in Lesson 6.
By this point in resuscitation, you most likely will have intubated the trachea, giving a more reliable means of ventilating, and called for additional personnel to record events. Because epinephrine administration seems likely, establishment of an umbilical venous line should be in progress.
Instructor Tip: A newborn who requires chest compressions is seriously ill and needs a skilled and coordinated team to administer interventions. This is why we practice these skills frequently, so that all team members feel confident and competent during a more extensive resuscitation.
The inflation of a flow-inflating bag depends on a sealed system. If the bag does not inflate, check for potential problems, such as those mentioned here.