Unexpected emergency delivery

What preparation is necessary to have for the unexpected emergency department delivery? 

Preparation is key, as most ED deliveries are “unexpected.” A prearranged plan should be set in motion as soon as birth is imminent. That plan should include the assembly of personnel who are best able to take care of the newly born infant.

A brief history should be obtained if possible, because it may affect the resuscitation. Most newborns who will need resuscitative interventions can be identified prior to birth.

Equipment and medications specifically for a neonatal resuscitation should be kept in a designated tray so they are quickly available.

Periodic inspection of this equipment for proper functioning and expiration dates of medication should become part of the routine upkeep of the neonatal resuscitation tray.

Equipment and Drugs for the Neonatal Resuscitation

Gowns, gloves, and masks
Warm towels and blankets
Bulb syringe
Meconium aspirator
Suction catheters (sizes 5-10 F)
Face masks (sizes premature, newborn, and infant)
Oral airways (sizes 000, 00, 0)
Anesthesia bag with manometer (preferably 500 mL, no larger than 750 mL)
Laryngoscope with straight blades (sizes 0 and 1)
Spare bulbs and batteries
Endotracheal tubes (sizes 2.5, 3.0, 3.5, 4.0) and stylet
Umbilical catheters (3.5 and 5 F)
Umbilical catheter tray
Three-way stopcocks
Nasogastric feeding tubes (8 and 10 F)
Needles and syringes
Chest tubes (8 and 10 F)
Magill forceps
Radiant warmer
Cardiorespiratory monitor with electrocardiogram leads
Pulse oximeter with neonatal probes
Suction equipment
Oxygen source with flowmeter and tubing
End-tidal CO detector
Laryngeal mask airway (optional)
Epinephrine 1:10,000
Sodium bicarbonate
Dextrose in water 10%
Normal saline, Ringer’s lactate
Resuscitation drug chart

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