Figure no. 1. Pre-transport thermo-equilibration (post-resuscitated) Newborn Central temperature 36.5-37.5 C < 36.5 C Normal Hypothermia Radiant warming table with servo-control Incubator Skin temperature - 36.5 C Temperature with 1.5 C > child temperature Reevaluate at 30 min. + Monitor - ventricular allure - respiratory frequency - hemoglobin saturation in oxygen Maintain the thermo equilibrium According to the birth weight and VG Normal temperature Normal weight Premature Blanket warming table Incubator + servo-control Bed (skin 36.5 C) Central temperature la interval checked every hour
Figure no. 2. Glycemia check and hypoglycemia treatment Newborn at risk Newborn without risk (that will be transported) Glycemia > 40 mg/dl < 40 mg/dl Repeated every 2 hours 1. Bolus: 2 ml/kg glucose 10% till transport is performed 2. Installed/ continue PEV with 80 ml/kg/24 hours Glycemia (at 30 minutes) > 40 mg/dl < 40 mg/dl Continue PEV 1. Repeat bolus of 2ml/kg glucose 10% 2. Increase rhythm PEV at 100 ml/kg/24 hours or Increase concentration of glucose la 12.5% Glycemia (30 minute) > 40 mg/dl < 40 mg/dl Continue PEV 1. Increase concentration of glucose to 15-20% (on umbilical or central catheter) > 40 mg/dl < 40 mg/dl Glycemia (30 minute) Continue PEV 1. See the hypoglycemia treatment protocol Check glycemia every 2 hours till transport.
Table 3. Transport equipment ------------------------------------------------------------------------------------------------------------------------ Equipment Transport incubator with servo-control* Cardio-respirator monitor * Puls-oximetru* Pomp for perfusion (3)* Transport ventilator * Oxygen and compressed air tubes (two and a half the needed quantity for transport) Laryngoscope with reserve batteries Aspiration System Thermometer Sanitary Materials Syringes: 1, 2, 5, 10, 50 ml Needles different sizes Branules 18, 20, 22 G Intubation sounds: 2.0, 2.5, 3.0, 3.5, 4.0 Taps with 3 ways Perfusion equipment Pneumotorax evacuate kit (suggestion: branula 16 G, taps with 3 ways, 20 m syringe l) Adhesive band (leucoplast) Umbilical catheterize kit: scalpel, anatomic and surgical pens, sterile compress, umbilical catheters de 3.5, 5, 6 Fr. Gavaj sounds Aspiration sounds Test-tubes for hemograme, biochemie, hemoculture Sterile tampons for cultures Sterile gloves and for examination Solutions and drugs Betadina Sanitary alcohol Sterile Compress Glucose 10% Physiologic ser Adenosine** Adrenaline 1/10 000 Ampicilin Atropine Sodium Bicarbonate Dexametazona Dopamine Dobutamin** Phenobarbital Furosemide Calcium Gluconate Heparin
Midazolam Prostaglandin E** Surfactant** Xilin ------------------------------------------------------------------------------------------------------------------------- * Equipments with dual power (accumulators and network) ** Optional Figura 4. Tratamentul tulburarilor de ritm cardiac la nou-nascut
Determinarea AV < 70/min 120-160/min > 180/min Bradicardie Ritm sinusal Tahicardie Figura 4.1 Figura4.2. Figura4.1 Abordarea pacientului cu bradicardie
Bradicardie Fiecare P- urmat de QRS Bradicardie siunsala P nu este legat de QRS Bloc atriovantricular Tonus vagal crescut Cateter venos lupus matern alte cauze in atriul drept Oxigen Se retrage cateterul PaO2 /SaO2 ph tensiune arteriala Normal Scazut scazut scazuta Oxigen bicarbonat/ tratament hipotensiune Ventilatie Rtim sinusal Bradicardie Atropina Figura4..2. Abordarea pacientului cu tahicardie
Tahicardie Fiecare P urmat de QRS Tahicardie sinusala (180-220/min) P si QRS nelegate Tahicardie supraventriculara (>220/min) Temperatura Semne de soc Semne de maladie congenitala de cord - soc Crescuta Normal Da absente Prezente Se opreste incubatorul Tratament soc Nu se trateaza tratament AV normal Tahicardie Manevre vagale Raspunde Nu raspunde Se monitorizeaza Adenozina AV normal Se monitorizaza Nu raspunde Cardioversie AV normal Nu raspunde Se monitorizeaza Se repeta cardioversia
Manevre vagale: A/ Se porneste inregistrarea ECG B/ Se efectueaza manevra vagala 1. Se stimuleaza nasofaringele 2. Se aplica o punga de gheata pe fata in regiunea nasului si fruntii. Aplicatia nu va depasi 30 secunde C/ Se documenteaza revenirea la ritm sinusal D/ Se monitorizeaza in continuare Administrarea de adenozina A/ Se porneste inregistrarea ECG B/ Se administreaza adenozina 1. Se incarca in o siringa 100 micrograme/kg adenozina, in o a doua 2 ml ser fiziologic 2. Se administreaza rapid adenozina (1-2 secunde) 3. Se administreaza rapid pe aceeasi cale 2 ml ser fiziologic C/ Se documenteaza revenirea la ritm sinusal D/ Se monitorizeaza in continuare ~n cazul absentei raspunsului se creste doza cu 50 micrograme/kg. Doza maxima - 250 micrograme/kg Efecte adverse: flushing, artimii, bradicardie, bloc, hipotensiune, detersa respiratorie Figura nr.5. Evaluarea existentei unei maladii congenitale de cord cu ajutorul SaO2
Determinarea SaO2/PaO2 Normal Scazut Test la hiperoxie Nu exclude PaO2 > 150 mmhg PaO2< 150 mmhg SaO2 <75% MCC Pot fi cu flux imcc putin probabila MCC probabila Probabilitate mare a MCC crescut Perfuzie cu prostaglandinae Creste PaO2 Creste TA Nici un efect
Figura 4. Conduita in caz de pneumotorax Suspiciune pneumotorax Confirmare radiologica (optional/ recomandat) Punctionare de urgenta Spatiul II intercostal pe linia medioclaviculara Spatiul V intercostal pe linia axilara medie Dezinfectia zonei Xilina -anestezie ; se monteaza robinetul cu 3 cai la siringa de 20 ml Punctionare branula or ac cu fluturas Directie antero-posterior directie spre anterior, superior si medial Se scoate firul de ghidaj in momentul trecerii de pleura Se conecteaza robinetul cu 3 cai + siringa Se aspira Se evacueaza aerul cu ajutorul robinetului cu 3 cai Continue aspiratia Aer Continue aspiratia; se poate instala tub de dren Optional Nu se aspira aer ; recul al Pistonului se opreste aspiratia
Materiale necesare pentru drenajul de urgenta al pneumotoraxului: Branula (angiocath 16 G) Robinet cu 3 cai Siringa de 20 ml Solutie de xilina Siringa pentru administrarea xilinei Comprese sterile Dezinfectant (alcool sanitary, betadina) Pentru drenajul in sistem inchis este necesara instalarea ulterioara a unui sistem de aspiratie