Newsletter - traditional
Spring 2008 A Complimentary Publication
2005 Revised Neonatal
At birth a rapid assessment should be done to see if
the neonate is full term, is breathing, crying and has
good muscle tone and if the amniotic fluid is clear.
Ventilation is required if the neonate is not
breathing or breathing ineffectively. This is
usually done with a bag/valve mask and 100%
oxygen. After 30 seconds of ventilation the
heart rate is checked. If it is less than 60, chest
compressions should be started. Resuscitation
is continued until the heart rate is consistently
greater than 100. If the heart rate is not
consistently over 60 within 30 seconds of starting
responsibility is the infant. Some facilities or chest compressions, Epinephrine should be given
providers have decided not to have NRP [neonatal down an endotracheal tube and IV fluids given
resuscitation protocol] certified providers, but the through an umbilical vein catheter. The neonate is
standard of care is the same and providers are still reassessed every 30 seconds for improving color,
held to the NRP certification guidelines. spontaneous breathing and increasing muscle tone.
Appropriate equipment and supplies also need to bereadily available and accessible. At a minimum this If you need assistance to evaluate a case involving
includes oxygen, appropriately sized bag and mask neonatal resuscitation, give us a call.
Source: American Academy of Pediatrics Neonatal Resuscitation Guidelines.
Risk factors that put the mother or baby at risk for
D e c i s i o n - T o - I n c i s i o n :
requiring resuscitation include [these are not all
C h a l l e n g i n g T h e 3 0
M i n u t e R u l e
The National Institute of Child Health and Human
Development (NICHD) Maternal-Fetal Medicine
Units Network conducted a recent observational study
to look at the outcomes from the time of a decision to
perform a C-section to the time of incision.
polyhydramnios/oligohydramnios [too much or The data came from only primagravid women [first
child] in active labor who had an infant that weighed
over 2500 gm. Indications for c-sections included:
nonreassuring fetal heart rate, umbilical cord
prolapse, placental abruption, placenta previa with
hemorrhage and uterine rupture. Over 11,000 cases
maternal narcotics within 4 hrs of delivery
The data clearly showed that more than one third of
all c-sections for these indications did not comply
Improving Hospital Care for
• when the decision-to-incision time was less than
30 minutes, the rates of fetal acidemia andintubation in the delivery room were higher
In the last issue we discussed the “5 Million LivesCampaign”, that is aimed at reducing harm in US health
• 95% of infants delivered in more than 31 minutes care facilities. One part of this initiative is improving
did not experience any increase in the incidence hospital care for surgical patients.
of hypoxic-ischemic encephalopathy, fetal deathor apgar scores <3 at 5 mins.
• only one in eight neonatal deaths occurred in the • preventing surgical site infections by appropriate use
group of infants delivered after 31 mins.
of prophylactic antibiotics and use of appropriate hair
Source: OB Management: Vol.19, No 10.
removal methods, glucose control in patients undergoing major cardiac surgery and maintaining normal
FDA News. Haldol
body temperatures in patients undergoing colonsurgery.
• avoiding adverse cardiac events by continuing beta-
blocker therapy for all patients taking a beta-blocker
before admission for surgery and during theirhospitalization
• preventing VTEs [venous thrombotic events, this
includes both deep vein thrombosis and pulmonary
associated with the administration of the
embolism] through use of intermittent pneumatic
antipsychotic medication, Haldol. This risk is
compression devices and graduated compression
administration or when given at doses higher than
unfractionated heparin, low-molecular weight heparin
or Coumadin. Short trips to the bathroom and walks upand down the halls are not enough to prevent VTE.
Injectable Haldol is approved by the FDA only
for • preventing VAP [ventilator acquired pneumonia] by
intramuscular injection, although there is a lot of
elevating the head of bed to 30-45 degrees at alltimes except when care is being provided, allowing
evidence in the medical literature that IV
patients that are sedated to come up daily to assess
administration is a common “off label” use for
their responsiveness and readiness to wean, and
severe agitation in the hospital setting. EKG
administering daily medication to prevent peptic
monitoring is recommended if Haldol is given
intravenously. Source: www.medscape.com
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Untersuchungsbericht über das Attentat auf Oberst Estermann (aus: «Der Exgardist», Nr. 67/1999, S. 94–101, und Nr. 68/2000, S. 130–136) Aufschluss über die Untersuchung wegen des Todes des neuernannten Kommandanten der Päpstlichen Schweizergarde, Oberst Alois Estermann, seiner Ehefrau Gladys Meza Romero und des Vizekorporals der Garde, Cédric Tornay, eingetreten am Abend des