PAEDIATRICS

ResponseMaternal risk factors
PROM >18hr, Bleeding 2nd/3rd trimester, Htn (Chronic/pregnancy), Substance use/drug use - Lithium, narcotics), DM, Maternal fevers/infection, Maternal chronic illness, Chorioamnionitis, Previous foetal death, no antenatal care

Foetal risk factors
Multiple gestations, Preterm (<35 wk) or post term (>41 wk), large for dates, foetal growth restriction, Autoimmune haemolytic disease (anti D), Polyhydramnios/oligohydramnios, Decreased foetal movement before labour, Congenital abnormalities, Intrauterine infection, Hydrops foetalis

Intrapartum risk factors
Non reassuring FHR on CTG, Abnormal presentation, Prolapsed cord
Prolonged labour (2nd stage), Antepartum haemorrhage (Abruption, placenta/vasa previa), Meconium liquor, Opioids <4h from delivery, Forceps/vacuum delivery, maternal anaesthesia
I have bolded some i might remember

ResponseOxygenation - RA initially then increase if not hitting targets
Ventilation PPV 5-8cm PEEP via T piece
CPR - Initiate if HR<60 or absent pulse, after 60 seconds of effective PPV
CPR rate 90/min, (90 compressions, 30 breaths)
CPR ratio 3:1
Adrenaline: 10-30 mics/kg - <37 weeks: 0.25 mL 1:10,000, >38 weeks 0.5 mL 1:10,000

ResponseETT size = gestation (weeks)/10 uncuffed (Cuffed -0.5)
ETT depth = weight +6cm
Adrenaline dose 10 mics/kg

ResponseAt any stage: DO YOU NEED HELP?

Term, breathing/crying, good tone? - things are good

Maintain normal temperature: Dry and place in warm resuscitation environment (Resuscitair)
Ensure airway open: Open airway and place head in neutral position. Gentle suctioning and remove secretions
stimulate the child (Stimulate = flick feet, rubbing back)

If HR <100, gasping or apnoea >> Positive pressure ventilation + O2 monitoring (R UL)
If breathing remains inadequate 5 breaths (or 30 seconds)
Reassess breathing and HR - ventilate at 30 breaths/min until regular breathing established
If HR <60 despite initial breaths commence CPR 3:1

• 100% oxygen
• Intubation or LMA + access - Umbilical line or IO
• IV adrenaline 10-30 mics/kg - <37 weeks: 0.25 mL 1:10,000, >38 weeks 0.5 mL 1:10,000
• Consider volume 10mL/kg N/S

Check BSL early, Replace glucose if <3
Antibiotics if concerns (eg: preterm labour)
Vitamin K 2mg

Note - Sats at birth ~60-70%, by 10 mins should be 85-90%

ResponseR upper limb
Pre ductal (ie R upper limb is supplied from LV, Blood from pulmonary artery goes through ductus arteriosus and joins Aorta resulting in mixed blood for LUL and both legs - confounding saturations)

ResponsePros:
Reliably delivers PEEP - Has manometer to measure/display actual PEEP (vs self inflating bag with PEEP valve which is poor) - Peep important in lung recruitment
Blending from RA and O2 - typically use RA to 30% FiO2

Cons
T piece will fail if gas supply fails (Self inflating bag will not)

ResponseFiO2 - Start with air, increase >21 % if not reaching target saturations in time
RR 40-60
PEEP 5-8
PIP - 30 Cm.H20 (<32 weeks use 20)

ResponseInsufficient oxygenation can impair organ function or cause permanent injury
Increased evidence that brief exposure to excessive oxygen can be harmful to newborn during resus

ResponseExamine the cut end of the cord and identify the two arteries (smaller, thicker walled and constricted) and the single vein (larger more gaping and thin walled)
Grasp the edge of the cord with suture forceps and use a probe or the fine tooth forceps to tease open the vein (usually easy)
5F umbi line
(probably better descriptors out there than this one)

ResponseAPGAR
Activity - Floppy =0, some flexion =1, flexed and resisting extension =2
Pulse - No pulse = 0, <100 = 2, >100 =2
Grimace - response to stimulation 0=none, grimace/weak cry =1, Cry =2
Appearance - 0=blue/pale everywhere, 1= Peripheral cyanosis, 2=pink
Respiration - 0=Absent, 1=slow+Irregular, 2=strong cry

Assess at 1 minute and 5 minutes
<3 = severely depressed
4-6 = moderately depressed
>7 = Good news!

ResponseSome role in hypoxic ischaemic encephalopathy to reduce brain injury - Commence within 6 hours (33-34 C) maintain for 72h

ResponseDelivery equipment - Episiotomy kit - Local anasthetic, Scissors, cord clamps
Otherwise this was very straight forward and extensive…. I have not wasted 4 pages. Name shit in a paediatric crash cart and a resuscitair would be a similar question - NSW2018.1-13 if I need to revise. You needed 8 things