This case is written by Dr. Kyla Caners. She is a staff emergency physician in Hamilton, Ontario and the Simulation Director of McMaster University’s FRCP-EM program. She is also one of the Editors-in-Chief here at EmSimCases.
Why it Matters
Approximately 10% of newborns require some degree of resuscitation upon delivery, with less than 1% requiring active resuscitation.1 Given that deliveries in the ED are relatively rare, this means that performing NRP in the ED is quite uncommon. On the other hand, the ED team must be able to respond quickly and efficiently to a flat neonate. This means that practising NRP is paramount – and what better way to do so than with simulation! This case highlights three key pieces of NRP, including:
- The need to warm, dry, and stimulate immediately
- The quick progression to positive pressure ventilation if stimulation doesn’t work
- When to initiate CPR, the necessary 3:1 compression:ventilation ratio, and how to place hands for performing CPR on a neonate
You are working in the minor area of your ED and have been called by the physician on the major side to assist with a precipitous delivery. He is managing the mother and wants you to be ready to resuscitate the infant if needed. The mom thinks she’s term. She’s had no prenatal care and is an IV drug user. She used earlier today. There no meconium staining noted in the amniotic fluid. Baby has just been delivered and is handed to your team.
The team has been called to help in the ED where a woman just precipitously gave birth to a baby now requiring resuscitation. The mom thinks she’s at term. She has had no prenatal care and is an iv drug user. The baby will be flat. After stimulation and drying, the baby will have a HR <100 and PPV will be required. After 60 seconds, the HR will still be <60 and CPR will need to be started. This will be short lived. The team will also need to intubate and obtain IV access.
Download the case here: NRP Case
- Barber CA, Wyckoff MH. Use and efficacy of endotracheal versus intravenous epinephrine during neonatal cardiopulmonary resuscitation in the delivery room. Pediatrics. 2006;118:1028–1034. doi: 10.1542/peds.2006-0416