NRP megacode

obtains relevant perinatal history
gestational age
fluid
expected number of babies
additional risk factors

performs equipment check
warm
clear airway
auscultate
oxygenate
ventilate
intubate
medicate
thermoregulate

discusses plan and assigns team members roles
use NRP key behavioral skills throughout resuscitation to improve teamwork and communication

completes initial assessment
term
tone
crying or breathing

meconium management
if not vigorous, assist with performs tracheal suction

performs initial steps
warm, clear airway if necessary, dry, remove wet linen, stimulate

evaluates respiration and heart rate
auscultate apical pulse or palpate umbilicus ( Heart rate less than 60 beats per minute, apneic or gasping.)

initiates positive-positive-pressure ventilation (ppv) with 21% oxygen
apply mask correctly, rate 40-60/minute

calls for aditional help, if needed
a minimum of 2 resuscitators necessary if PPV required

requests pulse oximetry
place probe on right hand before plugging into monitor

assesses for rising heart rate and oxygen saturation with first 5-10 breaths
HR remains below 60 bpm*
heart rate not rising, pulse oximetry might not be functioning

assesses chest movement and bilateral breath sounds
initially respond that bilateral breath sounds are absent and chest is not moving with PPV *

takes ventilation corrective steps (MR SOPA)
instructor decides how many corrective steps are necessary:
Mask adjustment and Preposition head.
Suction mouth and nose and Open mouth
increase Pressure ( do not exceed 40 cm H20)
use Alternative airway ( ET tube or LMA)

request assessment of bilateral breath sounds and chest movement
performs 30 seconds of effective PPV
bilateral breath sounds and chest movement are present

evaluates HR, breathing, and oxygen saturation
Heart rate remains below 60 bpm*
Apneic
pulse oximetry might not be funcitoning

intubates or directs intubation and assesses ET placement
intubation is recommended prior to beginning chest compressions

increases oxygen to 100% in preparation of chest compressions
increase oxygen concentration to 100% when chest compression’s begin**

initiates chest compressions coordinated with PPV
2 thumbs (preferred) on lower third of sternum,
3 compressions: 1 ventilation
compress one-third of the anterior-posterior diameter of the chest

calls for additional help
Complex scenario may require more help

After at least 45-60 seconds of chest compressions, evalute HR, breathing, and oxygen saturation scenario may require more help
HR remains below 60 bpm
Apneic
pulse oximetry might not be functioning

may consider intratracheal epinephrine while umbilical venous catheter ( UVC) is being placed
CC may be performed from head of infant after intubation. insert UVC 2-4 cm. hold or tape catheter to avoid dislodgement

after at least 45-60 seconds of chest compression’s evaluates HR, breathing, and oxygen saturatoin
Heart rate remains below 60 bpm
Apneic
pulse oximeter might not be functoining

administer or directs administration of IV epi
Epinephrine 0.1 to 0.3 ml/kg
flush UVC with 0.5 – 1 ml normal saline

after at least 45-60 seconds of CC, evaluate HR, breathing, and oxygen saturtoain
HR above 60 bpm
Occasional gasp
Pulse oximetry functioning

discontinues compression’s, continues ventilation at 40-60 breaths/minute
discontinue compressoins if HR above 60 bpm. reassess every 30 seconds

Based on scenario, identifies need for volume replacement
Risk factors: placenta previa, abruption, blood loss from umbilical cord
Solutions: normal saline, Ringers lactate or O Rh-negative packed cells
Dose: 10 ml/kg over 5-10 minutes
Route: Umbilical vein
Rate: over 5-10 minutes

Continue to monitor HR, breathing and oxygen saturation every 30 seconds during resuscitation
adjust oxygen based on oximetry and newborns age. Continue PPV until HR above 100 bpm with adequate respiratory effort ( newborn may remain intubated)

Directs post-resuscitation care
ongoing evaluation and monitoring
Communicate effectively with parent(s)