3. If the infant's heart rate is less than 100 beats per minute and/or the infant has apnea or gasping respiration, positive pressure ventilation via face mask should be initiated with 21 percent oxygen (room air) or blended oxygen using a self-inflating bag, flow-inflating bag, or T-piece device while monitoring the inflation pressure. Joshua Schechter, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. When should an expert be consulted in the emergency treatment of sinus tachycardia in children? Ninety percent of infants transition safely, and it is up to the physician to assess risk factors, identify the nearly 10 percent of infants who need resuscitation, and respond appropriately. What are the AHA and ERC recommended preductal oxygen saturation (SpO2) targets for neonates? Secure IV (preferred) or IO access. Avoid excessive ventilation. [45]. Which finding in intubated patients is an indication to end cardiopulmonary resuscitation (CPR)? Why does the AHA guidelines advocate for a for a systems-of-care approach for ACS? Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. If signs of ROSC are noted, go to PostCardiac Arrest Care. American Heart Association. Treat reversible causes. If epinephrine is administered via endotracheal tube, a dose of 0.05 to 0.1 mg per kg (1:10,000 solution) is needed.1,2,57, Early volume expansion with crystalloid (10 mL per kg) or red blood cells is indicated for blood loss when the heart rate does not increase with resuscitation.5,6, Use of naloxone is not recommended as part of initial resuscitation of infants with respiratory depression in the delivery room.1,2,5,6, Very rarely, sodium bicarbonate may be useful after resuscitation.6, Term or near term infants with evolving moderate to severe hypoxic-ischemic encephalopathy should be offered therapeutic hypothermia.57, Intravenous glucose infusion should be started soon after resuscitation to avoid hypoglycemia.5,6, It is recommended to cover preterm infants less than 28 weeks' gestation in polyethylene wrap after birth and place them under a radiant warmer. 2006 Dec. 71(3):283-92. Targeted education and training regarding treatment of cardiac arrest directed at emergency medical services (EMS) professionals as well as the public has significantly increased cardiac arrest survival rates. [QxMD MEDLINE Link]. [49]. Note that for defibrillation, it is important to make sure the pads are correctly placed. Approximately 10% of infants require help to begin breathing at birth, and 1% need intensive resuscitation. See the guidelines sections detailed later in the article. https://www.uptodate.com/contents/search. Give one shock, then resume chest compressions for two more minutes before giving a second shock. [Guideline] Nolan JP, Maconochie I, Soar J, et al. Hydrogen ion (acidosis): Consider bicarbonate therapy, Hypoglycemia: Check fingerstick or administer glucose, Hypothermia: Check core rectal temperature, Tension pneumothorax: Consider thoracostomy, Tamponade, cardiac: Check with ultrasonography, Thrombosis, coronary or pulmonary: Consider thrombolytic therapy, Arrest was not witnessed by EMS providers or first responder, Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation in whom a cardiovascular lesion is suspected; the decision to perform revascularization should not be affected by the patients neurological status, which can change. If chemical and electrical cardioversion continue to be unsuccessful, consider expert consultation for additional antiarrhythmics and rate-controlling recommendations. endobj 2. [Guideline] American Heart Association. What are the specific recommendations for emergent reperfusion in ACS? Ensure that the phone remains on speaker, if at all possible. Specific recommendations for emergent reperfusion include the following: For patients presenting in less than 12 hours of symptom onset, reperfusion should be initiated as soon as possible independent of the method chosen (class I), If fibrinolysis is chosen, fibrinolytics should be administered in the ED as early as possible according to a predetermined process developed by the ED and cardiology staff (class I), Fibrinolytic therapy is generally not recommended for patients presenting between 12 and 24 hours after onset of symptoms unless continuing ischemic pain is present with continuing ST-segment elevation (class IIb), Fibrinolytic therapy is contraindicated in patients who present more than 24 hours after the onset of symptoms (class III), Coronary angioplasty with or without stent placement is the treatment of choice when it can be performed effectively with a door-to-balloon time of less than 90 minutes by a skilled provider at a skilled PCI facility (class I), When fibrinolysis is contraindicated, PCI should be performed despite the delay, rather than forgoing reperfusion therapy (class I), Fibrinolytic therapy followed by immediate PCI (as contrasted with immediate PCI alone) is not recommended (class III), Administration of fibrinolytics in the prehospital setting ideally requires protocols using fibrinolytic checklists, 12-lead ECG interpretation, staff experienced in advanced life support, communication with the receiving institution, a medical director experienced in STEMI management, and continuous quality improvement (class I), Where prehospital fibrinolysis and direct transport to a PCI center are both available, prehospital triage and transport directly to a PCI center may be preferred (class IIb), Regardless of whether time of symptom onset is known, the interval between first medical contact and reperfusion should not exceed 2 hours (class I), In patients presenting within 2 hours of symptom onset, immediate fibrinolysis rather than primary PCI may be considered when the expected delay to primary PCI is more than 60 minutes (class IIb), In adult patients presenting with STEMI in the ED of a nonPCI-capable hospital, immediate transfer without fibrinolysis from the initial facility to a PCI center is recommended, instead of immediate fibrinolysis at the initial hospital with transfer only for ischemia-driven PCI (class I), ERC guidelines include one additional recommendation: When fibrinolysis is the treatment strategy, if transport times exceed 30 minutes, fibrinolysis using trained EMS staff is preferred.