About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.11 - Newly Born Care
EMT-Basic (Standing Orders)
EMT-Advanced (Standing Orders)
EMT-Paramedic (Standing Orders)
- 1.0 Routine Patient Care—dry, warm, position, stimulate.
- For newly born requiring resuscitation, see 2.12 Resuscitation of the Newly Born.
- Reassess airway by positioning and clearing secretions (only if needed):
- Place the newly born on back or side with head in a neutral or slightly extended position.
- Routine suctioning is discouraged even in the presence of meconium-stained amniotic fluid. Suction oropharynx then nares only if the patient exhibits respiratory depression and/or obstruction, see 2.12 Resuscitation of the Newly Born.
- Clamp and cut the umbilical cord:
- After initial assessment and after the cord stops pulsating.
- Leave a minimum of 6 inches of cord.
- Prevent heat loss by rapidly drying and warming:
- Remove wet linen, wrap newly born in blankets or silver swaddler (preferred) and cover newly born’s head.
- Assess breathing by providing tactile stimulation:
- Flick soles of feet and/or rub the newly born’s back.
- If newly born is apneic or has gasping respirations, nasal flaring, or grunting, proceed t2.12 Resuscitation of the Newly Born.
- Assess circulation, heart rate, and skin color:
- Evaluate heart rate by one of several methods:
- Auscultate apical beat with a stethoscope.
- Palpate the pulse by lightly grasping the base of the umbilical cord.
- If the pulse is < 100 bpm and not increasing, proceed to 2.12 Resuscitation of the Newly Born. Assess skin color; examine trunk and face; and mucus membranes.
- Record APGAR score at 1 minute and 5 minutes(see chart).
APGAR Scale
Feature Evaluated
2 Points
1 Point
0 Points
Activity (Muscle Tone)
Active Movement
Arms and legs flexed (Weak, some movement)
Limp or flaccid
Pulse
Over 100 bpm
Below 100bpm
Absent
Grimace (Irritability / Reflexes)
Cry, sneeze, cough, active movement
Grimace (some flexion of extremities)
No Reflexes
Appearance (Skin Color)
Completely pink
Body pink, extremities blue
Blue, pale
Respiration
Vigorous cry, Full breaths
Slow, irregular, or gasping breaths, weak cry
Absent
Note:
PEARLS:
- Newly born are prone to hypothermia which may lead to hypoglycemia, hypoxia and lethargy. Aggressive warming techniques should be initiated including drying, swaddling, and warm blankets covering body and head.
- Raise temperature in ambulance patient compartment.