1. Check that the light source on the laryngoscope blade is working. Place the infant supine and suction the mouth and oropharynx. Monitor the heart rate and color.
2. Hold the laryngoscope in the left hand and open the infant's mouth by sliding your right index finger between the infant's right upper and lower gums. Insert the laryngoscope into the infant's mouth by sliding the blade down against your right index finger. Push the tongue with the blade to the left.
3. Advance the blade and lift. You should be able to see the epiglottis. Remove your right index finger, holding the blade with left hand.
4. Pass the endotracheal tube along the right side of the mouth and advance it past the vocal cords. If a stylet is used, it should be gently removed while the tube is held firmly in place. The tip of the tube should not go past 2.5 cm beyond the cords.
5. Attach the resuscitation bag to the tube and listen for breath sounds, which should be equal on both the right and left chest. The infant's oxygen saturation should improve. A chest x-ray will confirm proper placement.
6. Paint the skin with tincture of benzoin and tape the tube securely.
CARDIAC MASSAGE If the heart rate is below 50 beats per minute with assisted ventilation, cardiac massage should be initiated by placing both hands around the infant's chest with two thumbs over the midsternum so that the sternum will be depressed two-thirds of the distance to the vertebral column at 120 compressions per minute. Cardiac massage may be stopped periodically to assess improvement, and ventilation and cardiac massage should be synchronized (1:3 ratio). The chest should expand, bilateral breath sounds should be heard in the axilla, and heart rate should increase if the resuscitation is effective and the endotracheal tube is in good position. In most instances it is possible to obtain an adequate response with the use of external cardiac massage and assisted ventilation. If there is no response to these measures, drug therapy should be considered. Any route of access to the circulatory system is acceptable, including a peripheral vein, the umbilical vein, or an umbilical artery.
UMBILICAL ARTERY CATHETERIZATION
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