EMT Lesson Plans

7.06– Special Populations Skills/Scenario Lab Station: Neonatal Resuscitation Instructor Guidance

Objectives: To treat a neonate that does not breathe readily after birth

Setup: You will need your cohort bag, an AED, suction, and an infant BVM. You will also need an infant or neonatal manikin

Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving Deploy your students in one team – have the rescuers do each station individually.

Sequence: All scenarios should transition through the following: Scene Size-Up

Scenario II: Depressed premature newborn

Scenario I: Depressed term newborn

Event: An EMS unit is birthing a 30 week pregnancy and has called you because they expect serious complications. You arrive and are handed a premature newborn with of about 4 lbs.

Event: You are backing up another EMS unit that called for help for a childbirth of twins. You arrive just as the first EMS unit hands you a wrapped up newborn that is roughly term.

Primary Assessment:

History:

Primary Assessment:

History:

Unresponsive Not breathing

30 weeks gestation No prenatal care Mom is heroin addict

Unresponsive Not breathing

Term infant

No complications

HR at brachial 82

HR at brachial 142

Mom is 28 and healthy

Actions: Drying/positioning/Stimulation/bulb syringe (no effect) BVM ventilation @ 40-60 breaths per minute (no effect) At next reassessment HR will be 52 – CPR @ 3 compressions: 1 breath should be started. No AED is practical at this point since the electrodes will likely exceed the chest size and VF is not common in neonates. Run this arrest for 6 minutes with students changing places. Debrief: - What caused the problem (Prematurity) - Why didn’t drying/positioning/suctioning work? (probably not developed enough to breathe) - What is the order of suctioning (mouth, then nose because newborns tend to begin breathing with nasal stimulation and you don’t want them aspirating whatever is in their mouth) - What is a normal breathing rate for a newborn? (40-60 bpm) - Why are the indications for CPR? (HR <60) - What is the ratio for CPR? (3 compressions to 1 breath for newborns).

Actions: Drying/positioning/Stimulation/bulb syringe (no effect) BVM ventilation @ 40-60 breaths per minute (patient starts breathing spontaneously at 10 bpm). BVM should continue then breathing will start at 50 bpm with crying after 2 minutes of bagging, still has cyanosis of hands and feet) Debrief: - What caused the problem (probably hypoxia) - Why didn’t drying/positioning/suctioning work? (probably too depressed) - What is the order of suctioning (mouth, then nose because newborns tend to begin breathing with nasal stimulation and you don’t want them aspirating whatever is in their mouth) - What is a normal breathing rate for a newborn? (40-60 bpm) - Why did we bag him at 10 bpm? (because that’s roughly normal for an adult, but not life- sustaining for a newborn) - Why are the hands/feet cyanotic? (that’s a normal finding in a newborn due to poor vasomotor control – it does not require treatment. Central cyanosis would).