Episode 23: The Emergency Delivery with Dr. Anand Swaminathan, MD, MPH and Dr. Jonathan Blau, MD

The Emergency Delivery Learning Points:

Preparation: Warmer, Warm blankets, Bulb suction, Airway devices, Hat/Zip Lock, T piece, UV line, Medications, EKG, Temp, People, Teams for mother and baby

* Get dedicated neonatal transfer team on board early if you are not in a NICU capable ED.

If you have an oxygen blender:

21% for term

40% for preterm

Initial Assessment: Check for good tone, breathing and crying. Know if baby is term or preterm.

Initial stabilization includes warming and drying the infant, positioning the airway, clearing secretions from the airway (if needed), and stimulating the infant,including flicking the soles of the feet or rubbing the infant's back.

Thermoregulation is extremely important: Drying, blankets, hat, thermal mattress, warmer

Effective PPV for 30 seconds and reassess, continue PPV if signs of improvement (e.g. heart rate improving). 

If PPV is not working, use MR SOPA:

M - Mask Adjustment

R - Reposition Airway (Head neutral or slightly extended)

S - Suction Mouth and Nose

O - Open Mouth (lift jaw forward) / Oxygen (increase)

P - Pressure Increase ( 5-10 cm H2O increments, max 40 cm H2O)

A - Alternate Airway (ET tube or laryngeal mask)

Medication Spotlight: Epinephrine (1:10,000) IV

-only medication you need ready to go. 

Access: UV line or IO

Be aware of the expected O2 saturation and don't immediately jump to 100% oxygen:

Targeted Preductal SpO2 After Birth 

1 min 60%-65% 

2 min 65%-70% 

3 min 70%-75% 

4 min 75%-80% 

5 min 80%-85% 

10 min 85%-95%