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
2.12 - Resuscitation of the Newly born
EMT-Basic (Standing Orders)
EMT-Advanced (Standing Orders)
- 1.0 Routine Patient Care
- Maintain an open airway and suction the mouth, then nose. If meconium (brown stained fluid) is present, suction the hypopharynx only if the infant is not vigorous
- (Contact ALS immediately if available for possible need of endotracheal intubation).
- Dry the infant, place on a dry blanket, cover the head and keep the infant warm.
- If ventilations are inadequate or chest fails to rise, reposition head and neck, suction and initiate positive pressure ventilation at room air for term newborns or for preterm (less than 38 weeks gestation) newborns at 40-60 breaths per minute, as clinically indicated.
- For heart rate less than 60, institute positive pressure ventilation with 100% oxygen for 1 minute and if heart rate remains at 60 start chest compressions.
EMT-Paramedic (Standing Orders)
- If meconium is present, consider early endotracheal intubation and suctioning. (Note: Do not suction or intubate a neonate with a vigorous cry).
- Newly born in distress and requiring emergency care:
- For heart rate 60-80 and rapidly rising:
- Continue manual ventilation at room air for term newborns or for preterm (less then 38 weeks gestation) newborns at 40-60 breaths per minute
- Cardiac Monitor – Manage dysrhythmias per protocol.
- For heart rate less than 60:
- Initiate CPR as indicated.
- Institute positive pressure ventilation with 100% oxygen for 1 minute and if heart rate remains at 60, start chest compressions.
- Continue manual ventilation with 100% oxygen after CPR is initiated.
- Advanced airway management if not already done and perform capnography.
- Cardiac Monitor. Manage dysrhythmias per protocol.
- If defibrillation is indicated: initial energy level: 2 joules/kg subsequent: 4 joules/kg.
- If synchronized cardioversion is indicated: 0.5-1 joules/kg.
- Establish IV or IO access, if indicated. (Note: appropriately trained and authorized EMT-Paramedics may utilize umbilical lines when necessary). Treat for shock with 10cc/kg of Normal Saline over 5-10 minutes.
EMT-Paramedic (Medical Control)
- Epinephrine 1:10,000 (0.01-0.03 mg/kg) IV/IO
- Epinephrine Infusion: Administer 0.1-1 mcg/kg/min IV/IO
Note:
The newly born should be evaluated for central cyanosis. Peripheral cyanosis is common and may not be a reflection of inadequate oxygenation. If central cyanosis is present in a breathing newborn during stabilization, early administration of 100% oxygen is important while the newborn is being assessed for need of additional resuscitative measures.