Premature Neonate CPR

SammyGirlMedic said:
Where I work as a Medic, I am aware of which hospital has a neonatologist on staff and I would take the child to that hospital. The neonatologists will respond to the ER for a case such as this. He/She knows a hell of a lot more than I do!
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Again, although they might know more, what are they going to do for this neonate without vital signs that you aren't?? NRP is the same, no matter who is doing it.
 
VentMedic said:
We're past the "RUN!!!" part.

Remember your "seriously" remark in your reply to Medic744 who also didn't take her seriously?
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I WOULD take her seriously!! I was saying I am SURE it DOES hurt!!! I just said lol because hmmm, we've all seen women in labor.. the word pain looks like an understatement!
Why are you picking apart my posts?
I am not a bad person. I didn't realize I had to be dead serious on here. I thought it would be a nice online "community" of people with whom to chat. :huh:
Thanks for moving past the RUN part. I'm glad you moved on to a new part of my post to "grade." Maybe eventually you'll finish the entire thing! That would be great! Thanks!
 
redcrossemt said:
Again, although they might know more, what are they going to do for this neonate without vital signs that you aren't?? NRP is the same, no matter who is doing it.
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What if I had trouble with the intubation? What if I had trouble with gaining access for medications/fluids?
I am confident in a lot of my skills.. but I also know in this case, I am no expert in NRP. Not every case is going to be textbook. We can study it all we want. So, yes, I'd want to get that baby to someone who IS an expert. Is that wrong?
 
Again, although they might know more, what are they going to do for this neonate without vital signs that you aren't?? NRP is the same, no matter who is doing it.
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The hospital will likely do the same resuscitation as out in the field however, if EMS is successful in getting a ROSC, the physician can than start to provide the post-resuscitation care and hone in on a cause of the arrest much sooner if EMS doesn't mess around on the scene. So, I would say time is valuable and it would be prudent to get the kid to a hospital as quickly AND efficiently as possible.

SammyGirlMedic... I warned ya ;)
 
SammyGirlMedic said:
What if I had trouble with the intubation? What if I had trouble with gaining access for medications/fluids?
I am confident in a lot of my skills.. but I also know in this case, I am no expert in NRP. Not every case is going to be textbook. We can study it all we want. So, yes, I'd want to get that baby to someone who IS an expert. Is that wrong?
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I'm not saying it's wrong, just wondering what the school of thought is in transporting this patient.

We kill providers, patients, and bystanders each year emergently transporting dead people. It's worth taking a look at whether or not transporting these patients is necessary.

In our system, we pronounce on-scene much of the time, and do not transport arrests emergently (and typically not at all) unless we can not obtain vascular access or an airway.
 
18G said:
The hospital will likely do the same resuscitation as out in the field however, if EMS is successful in getting a ROSC, the physician can than start to provide the post-resuscitation care and hone in on a cause of the arrest much sooner if EMS doesn't mess around on the scene. So, I would say time is valuable and it would be prudent to get the kid to a hospital as quickly AND efficiently as possible.

SammyGirlMedic... I warned ya ;)
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What is post-resuscitation care for the 23 week old neonate?
 
Wrong with these few? Perhaps because "these few" know what they are talking about, and choose logic, research, and common sense over emotion.[/QUOTE]

Emotion always seems to be a part of medicine, in all areas of it! Hard to get away from it sometimes.
It's great that you know what you are talking about... kudos to you!!
 
What is post-resuscitation care for the 23 week old neonate?
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The post-resuscitation care is whatever is required to support the life of the neonate and identify/correct the cause of the arrest which includes arranging for inter-facility transport to a specialty center.

I am not an expert in caring for a neonate and I'm sure your not either. Rarely does EMS encounter a neonate in need of resuscitation. If your an expert in neonatal care that's awesome. There must be a lot of pre-hospital deliveries where you live.

Its much harder to keep a person from coding then it is to treat them once they have coded. So yeah, if I get a ROSC back on a neonate I want someone more qualified than myself to make sure they keep that ROSC.
 
VentMedic & redcrossemt,

Thank you for pointing out what I said in my post. It really made me stop and think about what I would do.
It is soooooooo nice to have people to talk to who are experts in this type of situation. I definitely am not!!
;)
 
VentMedic said:
Seriously? If the placenta still has not deliver and this was not a term birth which makes a premature birth "abnormal" there are many possibilities of things going wrong especially with the mother which caused her to go into premature labor. Seriously?
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No to change the subject, but now I'm confused. I thought it was normal for the placenta to not deliver until up to 30 minutes later in a full term delivery. If we are within that time frame how does the placenta not being delivered yet indicate something is wrong?

I understand that pre-term labor and delivery is not normal and that in itself indicates something is wrong with the baby or mother, it is just the placenta part of that I'm curious about.
 
SammyGirlMedic said:
VentMedic & redcrossemt,

Thank you for pointing out what I said in my post. It really made me stop and think about what I would do.
It is soooooooo nice to have people to talk to who are experts in this type of situation. I definitely am not!!
;)
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I'm no where near an expert in neonatal resuscitation myself, but I have read some research, been through the training, and think I have some other experiences (clinically and educationally) that can be of use to the conversation. I like hearing the other side of the story too, and appreciate the comments made by Vent, 18G, and yourself.

I think this is a good conversation, as many would not have thought about what they would do until they have regrets after a call. It's good to bring up these things once in a while so we can all figure out a plan in our heads.
 
18G said:
The post-resuscitation care is whatever is required to support the life of the neonate and identify/correct the cause of the arrest which includes arranging for inter-facility transport to a specialty center.
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I guess it depends on if it is an after-birth arrest, or if the patient simply isn't breathing because they are too immature to do so... Sometimes the best thing may be stabilization on-scene, with a little longer transport time to a specialty facility.
 
Aidey said:
No to change the subject, but now I'm confused. I thought it was normal for the placenta to not deliver until up to 30 minutes later in a full term delivery. If we are within that time frame how does the placenta not being delivered yet indicate something is wrong?

I understand that pre-term labor and delivery is not normal and that in itself indicates something is wrong with the baby or mother, it is just the placenta part of that I'm curious about.
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Not sure how much time has lapsed since the first guess was 10 minutes since the baby was born and then another unit was called and it had time to arrive.

I wouldn't take my eyes off the mother especially if she is still having pain. I don't remember any prenatal care for the mother. It also wouldn't be unheard of to have premature twins. There was also no mention of the cord and its appearance or number of vessels but then that would be a little advanced although it is mentioned in NRP.
 
SammyGirlMedic said:
VentMedic & redcrossemt,

Thank you for pointing out what I said in my post. It really made me stop and think about what I would do.
It is soooooooo nice to have people to talk to who are experts in this type of situation. I definitely am not!!
;)
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Have you considered finishing your RN to really get into the NICU?

If your NICU has a Specialty transport team that is quality, the experience and rewards of being part of it are incredible.
 
VentMedic, I see you are an RRT..
have you worked Neonatal ICU? That is great if you have... (or even if you haven't for that matter.)
Our RRTs are outstanding. Thankfully, they are very approachable and share their knowledge with the rest of us in a calm, non-condescending manner. ;)
 
SammyGirlMedic said:
VentMedic, I see you are an RRT..
have you worked Neonatal ICU? That is great if you have... (or even if you haven't for that matter.)
Our RRTs are outstanding. Thankfully, they are very approachable and share their knowledge with the rest of us in a calm, non-condescending manner. ;)
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Yes, NICU, transport and ECMO.

We are pretty outstanding if I do say so myself. B)
 
VentMedic said:
Have you considered finishing your RN to really get into the NICU?

If your NICU has a Specialty transport team that is quality, the experience and rewards of being part of it are incredible.
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Oh yes, I have 15 months to go in my LPN to BSN program so I can "really get into the NICU."
Our NICU is well-renowned in the state of Ohio and has a very high-quality Neonatal transport team. I would love to be a part of it someday.
 
SammyGirlMedic said:
Oh yes, I have 15 months to go in my LPN to BSN program so I can "really get into the NICU."
Our NICU is well-renowned in the state of Ohio and has a very high-quality Neonatal transport team. I would love to be a part of it someday.
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You keep going for it girl!

Nothin' better than messin' with the preemies and watching each one develop their own special little NICU personality.

And yes, my attitude is part NICU prima donna and part arrogant Paramedic.
 
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VentMedic said:
Yes, NICU, transport and ECMO.

We are pretty outstanding if I do say so myself. B)
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That's great. You were very quick to jump down my throat I must say... I didn't claim to be an expert did I? I just answered the question about what I would do. You could've used the opportunity to give me your expert opinion in a way that would make me really think and not immediately try to make me think I was dead wrong.
They say nurses eat their young.. but so do many others!
And no one scared me away.. I'll be around! Thanks for your time! :)
 
VentMedic said:
You keep going for it girl!

Nothin' better than messin' with the preemies and watching each one develop their own special little NICU personality.

And yes, my attitude is part NICU prima donna and part arrogant Paramedic.
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Confidence is a wonderful thing. If I had a sick baby, I would want someone with that attitude rather than someone who is unsure.
But, give me a chance. I have only been in EMS 11 years and an LPN for 9. I don't claim to know it all and never will. I came here to chat and learn a thing or two. ;)
 
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