Neonatal Topics - Neonatal Resuscitation Program

ABC? LMP? EDC? Where do I begin? This lecture covers the very important medical and obstetric questions that must be covered during the history portion of the exam. Information obtained from the Prenatal Record (PNR) and its significance will also be reviewed. Variations in the physical exam will be discussed as they related to normal physiologic changes. Finally, a detailed discussion of obstetric related exams such as status of the membranes, dilatation, effacement, presentation, station and lower uterine segment pressure will all be covered. You won’t be afraid of those pregnant ladies anymore!

The discovery of Insulin has made dramatic changes to the care of Insulin dependant pregnant patients. Before insulin, most diabetic patients were infertile or had multiple early losses of their pregnancy. Insulin now allows many diabetic women to actually become pregnant and maintain their pregnancy until a viable fetus can be delivered. That being said, the diabetic pregnant patient is fraught with medical and obstetric complications for both the maternal and fetal patient. The placenta secretes hormones that are antagonistic to insulin and the hyperglycemic environment can leads to tremendously higher fetal anomalies and losses. Unfortunately, this is only the beginning for the diabetic pregnant patient. This lecture will discuss the pathophysiology of diabetes in pregnancy, the changing insulin needs of the diabetic mother, maternal concurrent medical/obstetric complication and potential fetal complications. Assessment and management priorities will be reviewed.

FHR interpretation can be a challenge for non-OB folks. Honestly, what do all of those “squiggles” mean? Competent care of the fetus means more than “taking care of the mom.” Specific care & treatment of the fetus can be initiated after accurate assessment of the FHR tracing is complete. Incorporating both AWHONN & ACOG principles, FHR baseline assessment changes, along with common deceleration patterns including etiology, risk, and treatments will be reviewed. The participant will learn to recognize ominous FHR tracing patterns and initiate appropriate treatments. The class concludes with numerous high-risk OB scenarios with associated FHR tracings for interpretation.

Immediate Vaginal Delivery

“The baby is COMING!”…. Unless you have “Obstetrician” after your name, no one wants to hear this phrase. The purpose of this lecture is to first identify signs of imminent vaginal delivery. Then there will be a detailed review of the procedure for vaginal delivery. Complications such as nucal cord, prolapsed umbilical cord, meconium and breech presentation will also be discussed. Immediate care of the maternal and neonate will be listed. A review of NRP principles will be given to aid in neonatal transition to extra-uterine life. In addition, discussion of immediate care to the post partum mom will be reviewed including managing vaginal lacerations, delivery of the placenta, uterine atony, and post partum hemorrhage. Finally, we end the lecture by convincing the parents to name the baby after you…just kidding!

Course length: 60 minutes

Speaker: Teri Campbell, RN, BSN, CFRN

Oh no…she’s PREGNANT! One patient or two? This lecture will begin with a review of the most common obstetric trauma etiologies such as blunt, penetrating, burn and domestic violence. A review of fundal height assessment will help you decide if you truly have one patient or two. Inferior Vena Cava Syndrome (IVCS) is a simple principle that can make the difference between life and death for your maternal and fetal patient. We no longer subscribe to the cliché of “if we save the mom, we will save the baby”. The truth is there are numerous techniques you can be using concurrently to optimize both maternal and fetal outcomes. We will then proceed to the primary survey where obstetric considerations will be discussed such as airway failure rates and useful “tricks of the trade” pearls. Assessment and management priorities of the secondary survey will also take into account obstetric considerations. It is only during the secondary survey that fetal assessment and uterine assessment is attempted. Review of hypovolemic presentation for the obstetric patient will be reviewed as the pregnant patient may be in Class III shock before there is a change in the maternal B/P. A discussion related to ACLS guidelines specifically for the obstetric patient will be covered. Finally, the concept, practicality and preparation for a perimortem cesarean section will be discussed.

Course length: 60 minutes

Speaker: Teri Campbell, RN, BSN, CFRN

In order to understand the potential pathologies that can be associated with pregnancy it is necessary to have an understanding of the normal physiologic changes that occur to the maternal system during pregnancy. The pregnant body literally becomes a “lean, mean, baby machine”! Excluding pathology, every system in the body becomes more efficient and expansive to accommodate the growing maternal and fetal needs. Does a high heart rate and lower B/P mean hypovolemia or is this a normal adaptation during pregnancy?

“Power N.A.P.” is intended for experienced transport team members who currently hold certifications in ACLS, PALS, & NRP and are desiring a “crash course” for recertification. Scheduling requires a confirmed enrollment of at least 15 attendees and a maximum of 50. Course includes all professional instruction, certificate of attendance, and course completion cards. Books and handouts are responsibility of sponsoring institution. For more information or a course outline, please call 1-888-280-7337 or e-mail us at education@peds-r-us.com.

Course length: 12-hours, One day
Speakers: Scott DeBoer RN,MSN,CEN,CCRN,CFRN
Intended Audience: Transport Teams

Pregnancy Induced Hypertension is an umbrella statement that includes chronic hypertension, gestational hypertension, pre-eclampsia, superimposed pre-eclampsia and eclampisa. Yikes! This lecture helps to unravel the complicated patho-physiology related to these disease states. You will now understand on how each maternal body system is affected by these disease states. These can truly be the most critically ill obstetric patients that you will ever care for. Consequences to the fetal system will also be considered. Treatment modalities and priorities will be discussed. Detailed review of pharmacology with mechanism of action, side effects, assessment parameters and contraindications will be discussed. Hemolysis, Elevated Liver and Lower Platelets (HELLP) is an acronym used to describe and extending potential complication of pre-eclampsia. Definition, presentation and management options will be reviewed for this obstetric disease state.

PTL is one of the most common reasons for perinatal transport and certainly and area that gives much angst to the transporting team. The pregnant patient may follow a typical pattern of labor and delivery or she may refuse to read the “manual” and deliver when ever she feels like it! If the thought of this makes your throat (and other areas) tighten then you should come to this lecture. Possible etiologies such as maternal, fetal, medical and obstetric causes will be discussed. A detailed review of common as well as “last ditch” treatment modalities will be discussed. A thorough review of current medication used including mechanism of action, side effects and contraindications will be given. We will discuss labor curves for the primigrava as well as for the multipara patient. Finally, there will be a discussion of Preterm Premature Rupture of Membranes (PPROM) and its clinical significance for both the maternal and fetal patient.

Transporting the critically sick neonate or child is a challenge to emergency personnel requiring specialist knowledge, skills and age appropriate equipment suitable for all ages. In Sydney regionalized tertiary centers provide specialized care for specific illnesses in specific age groups. Often, it is imperative to transport a sick child or neonate to one of these centers where specialised medical and nursing care plus particular technical and diagnostic facilities are provided. This three hour session explores some of the pitfalls associated with transporting critically sick infants and children alongside essential stabilisation measures to avoid disastrous consequences. Case scenarios will be examined and critiqued to enhance learning outcomes.

Course length: 3-hours
Speaker: Ella Scott RN,RSCN,BA,MA
Intended audience: Paramedics, ER, Pediatric, Critical Care Nurses, & Respiratory Therapists

Formally known as N.A.L.S., this course will provide attendees with an American Academy of Pediatrics Neonatal Resuscitation Provider (NRP) card after successful completion of skills stations and a written test. Unlike typical NRP courses, all lectures and didactic information are presented from the perspective of the EMS & transport environments. In addition to the required NRP material, this course reviews the essential components of a rapid neonatal assessment, as well as initial/transport management of common (& not so common) medical & surgical neonatal emergencies. Surviving Neonatal Resuscitation is unlike any NRP course you have taken and will help give you the skills and confidence that you and your patients need to survive. For more information or a course outline, please call 1-888-280-7337 or e-mail us at education@peds-r-us.com.

Course length: 8-hours, One day
Speaker: Scott DeBoer RN,MSN,CEN,CCRN,CFRN
Intended Audience: Paramedics, ER, Pediatric, Critical care nurses, respiratory therapists, & transport teams

We all have to admit that we love to hear incredible stories, see amazing pictures, & learn from other’s experiences. While pediatric cases tend to tug at the heart strings, they also are filled with laughter, fun, & unsurpassed learning opportunities. This interactive presentation will discuss unusual pediatric & neonatal transport cases.

Course length: 60 minutes
Speaker: Sherri Dean RN,BSN,CCRN,CFRN
Intended audience: Paramedics, E.R., Pediatric, I.C.U. Nurses, & Respiratory Therapists

This presentation discusses the use of inhaled Nitric Oxide (iNO) during transport. Disease processes that benefit from the use of iNO and contraindications are discussed. Prior to FDA approval of iNO, the administration was reserved for institutions active in research and the transport systems affiliated with these institutions. We are now seeing patients placed on iNO prior to critical care transport and this is having a dramatic effect on the care & transport of these infants.

Course length: 60 minutes
Speaker: Sherri Dean RN,BSN,CCRN,CFRN
Intended audience: Neonatal ICU staff & transport teams

“I never knew anyone could bleed that much and still live”. A direct quote from an L&D nurse caring for a 3^rd trimester bleeding patient. In this lecture there will be discussion regarding the most common cause of intrapartum bleeding such as Placenta Previa, and Placenta Abruptio. Common presentations vs. “text book” presentations will be discussed. Management priorities and potential complications will be reviewed. Post partum hemorrhage may also be significant and quite frankly after the stress of delivering this kiddo, you really don’t want to handle this too! Definition of PPH, possible causes and treatment priorities/techniques will be itemized. Finally, a review of objective measurement of estimated blood loss (EBL) will discussed.

Hypothermia continues to be a contributing factor to morbidity & mortality of the neonate despite advances in thermoregulation. By understanding the complex physiologic response to cold stress (i.e. pulmonary hypertension), the transport team can better anticipate & intervene to improve outcomes.

Course length: 60 minutes
Speaker: Sherri Dean RN,BSN,CCRN,CFRN
Intended audience: Neonatal ICU staff & transport teams