Pediatric Village Delivery Orientation - Revision history

JenniferH: /* Preparing to go out for a village delivery */

2021-01-25T21:46:30Z

Preparing to go out for a village delivery

← Older revision		Revision as of 21:46, 25 January 2021
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	*Make sure you have '''warm''' clothing/appropriate gear, snacks, drinks, money etc. There is some small/medium women’s warm gear and boots on and next to the coat tree next to peds hospitalist office		*Make sure you have '''warm''' clothing/appropriate gear, snacks, drinks, money etc. There is some small/medium women’s warm gear and boots on and next to the coat tree next to peds hospitalist office
	*Get curosurf from OB refrigerator and place in small cooler tube to take with you on the medevac		*Get curosurf from OB refrigerator and place in small cooler tube to take with you on the medevac
	*Make sure FM physician has picked up their OB med kit and supply bag (plus Fetal Fibronectin and GBS swabs etc. for preterm labor patients)		*Make sure FM physician has picked up their [[Village Delivery Go Bag\|OB med kit and supply bag]] (plus Fetal Fibronectin and GBS swabs etc. for preterm labor patients)

	===Before you leave===		===Before you leave===

JenniferH at 04:09, 5 December 2020

2020-12-05T04:09:01Z

← Older revision		Revision as of 04:09, 5 December 2020
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			'''''see [[media:Village_delivery_(peds).pdf\|Village Deliveries Resource]] for a concise and printable version of the information below.'''''

	===Preparing to go out for a village delivery===		===Preparing to go out for a village delivery===
	*Get information about prenatal history and risk factors for baby		*Get information about prenatal history and risk factors for baby

JenniferH: /* Medications Available With Medevac Team */

2020-11-21T08:19:05Z

Medications Available With Medevac Team

← Older revision		Revision as of 08:19, 21 November 2020
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	*Dexamethazone		*Dexamethazone
	*Pen G		*Pen G


			[[:Category:OB & Newborn\|OB & Newborn Main Page]]

Mfaubion: Mfaubion moved page Village Delivery Orientation to Pediatric Village Delivery Orientation: Jane wants Pediatric in the page name

2018-02-13T00:57:55Z

Mfaubion moved page Village Delivery Orientation to Pediatric Village Delivery Orientation: Jane wants Pediatric in the page name

← Older revision	Revision as of 00:57, 13 February 2018
(No difference)

Mfaubion: /* Neonatal Bag */

2018-02-12T22:20:00Z

Neonatal Bag

← Older revision		Revision as of 22:20, 12 February 2018
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	*For sick infants that require medevac to anchorage, complete admission orders, medication reconciliation, discharge order, charges and admit/transfer note.		*For sick infants that require medevac to anchorage, complete admission orders, medication reconciliation, discharge order, charges and admit/transfer note.

	===''Neonatal Bag''===		===Neonatal Bag===
	'''Outside Red Pocket'''		'''Outside Red Pocket'''
	* Anesthesia Bag with infant and neonate masks		* Anesthesia Bag with infant and neonate masks
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	* Surgical Gown		* Surgical Gown
	* Catheterization Trays x2		* Catheterization Trays x2
			* Pneumothroax Kit x2
			* Procedure Instructions
			* Povidone Swabs x2
			* Povidone Pads x 4
			* 3 way Stopcock x 1
			* 18ga 1 ¼ x 2
			* 20ml Syringe x1

	'''Neo Puff Bag'''		'''Neo Puff Bag'''
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	* Bulb Syringe x2		* Bulb Syringe x2

	'''''White Pouch'''''		'''White Pouch'''
	* Neo Arm Board x2		* Neo Arm Board x2
	* Ped Arm Board x2		* Ped Arm Board x2
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	* Amber Microtainer		* Amber Microtainer
	* 3 cc Syringe		* 3 cc Syringe

	~~'''Main Compartment'''~~
	* Pneumothroax Kit x2
	* Procedure Instructions
	* Povidone Swabs x2
	* Povidone Pads x 4
	* 3 way Stopcock x 1
	* 18ga 1 ¼ x 2
	* 20ml Syringe x1

	'''Green End Pocket'''		'''Green End Pocket'''
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	* Neo BP Cord		* Neo BP Cord

	~~'''''Outside Orange Pocket'''''~~
	'''Orange Pouch'''		'''Orange Pouch'''
	* Isolation Transport bags x2		* Isolation Transport bags x2

Mfaubion: /* Pack Supplies For Preterm Village Delivery */

2018-02-12T22:18:01Z

Pack Supplies For Preterm Village Delivery

← Older revision		Revision as of 22:18, 12 February 2018
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	*For well infants, complete admission orders/med reconciliation, charges and admission H&P. Transfer to FM service if indicated		*For well infants, complete admission orders/med reconciliation, charges and admission H&P. Transfer to FM service if indicated
	*For sick infants that require medevac to anchorage, complete admission orders, medication reconciliation, discharge order, charges and admit/transfer note.		*For sick infants that require medevac to anchorage, complete admission orders, medication reconciliation, discharge order, charges and admit/transfer note.

	~~===Pack Supplies For Preterm Village Delivery===~~

	===''Neonatal Bag''===		===''Neonatal Bag''===

Mfaubion: /* Neonatal Bag */

2018-02-10T01:54:20Z

Neonatal Bag

Show changes

Mfaubion: /* Neonatal Bag */

2018-01-29T20:50:45Z

Neonatal Bag

← Older revision		Revision as of 20:50, 29 January 2018
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	===Pack Supplies For Preterm Village Delivery===		===Pack Supplies For Preterm Village Delivery===

	====Neonatal Bag====		====''Neonatal Bag''====

	'''Main Compartment'''		'''Main Compartment'''

Mfaubion: /* When baby is stable and ready for transport */

2018-01-29T20:48:43Z

When baby is stable and ready for transport

← Older revision		Revision as of 20:48, 29 January 2018
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	*Remember that NICU docs are available for consultation 907-212-3614		*Remember that NICU docs are available for consultation 907-212-3614

	===~~When baby is stable and ready~~ for ~~transport~~===		===Preparing for Transport from Village Clinic===
	* Transfer patient to warmed isolette if it is at the clinic.		*Transfer patient to warmed isolette if it is at the clinic.
	* Make sure to communicate to hospital staff and they are prepared to receive the infant in Bethel		*Make sure to communicate to hospital staff and they are prepared to receive the infant in Bethel
	* If applicable, confirm a neonatal medevac is on its way--it takes a minimum of two hours to get from Anchorage to Bethel		*If applicable, confirm a neonatal medevac is on its way--it takes a minimum of two hours to get from Anchorage to Bethel
	* Transfer the patient as warm and stable as possible to the plane—in the isolette.		*Transfer the patient as warm and stable as possible to the plane—in the isolette.
	* Keep the patient warm on transport		*Keep the patient warm on transport
	* If patient is intubated use		*If patient is intubated use an anesthesia bag for best bagging control. Take turns bagging to avoid fatigue and ensure good ventilation…and BE CAREFUL NOT TO EXTUBATE A PATIENT. It is easy to do…
	an anesthesia bag for best bagging control. Take turns bagging to avoid fatigue and ensure good ventilation…and BE CAREFUL NOT TO EXTUBATE A PATIENT it is easy to do…
			===Return From Transport===
			*If baby is not delivered return to the hospital from the airport, with the team or in your car, and remain available for any potential high risk delivery
			*If baby was delivered in the village, you may need to accompany the team from the plane to the hospital and get your car later
			*For sick infants, continue stabilizing infant at the hospital and make sure NICU medevac team is on the way or already at the hospital for high-risk infants. When NICU team arrives, ask them to allow you to continue to do procedures. Stay involved with the management and care.The baby is the pediatrician’s responsibility until care is transferred to the medevac team as
			*For well infants, complete admission orders/med reconciliation, charges and admission H&P. Transfer to FM service if indicated
			*For sick infants that require medevac to anchorage, complete admission orders, medication reconciliation, discharge order, charges and admit/transfer note.

	===Pack Supplies For Preterm Village Delivery===		===Pack Supplies For Preterm Village Delivery===

Mfaubion: /* If the baby is born and not doing well… */

2018-01-29T20:43:49Z

If the baby is born and not doing well…

← Older revision		Revision as of 20:43, 29 January 2018
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	*See UV placement instructions below		*See UV placement instructions below

	===If the baby is born and ~~not~~ doing ~~well…~~===		===If the baby is born and NOT doing well===
	* Ventilate infant with bag-mask.		*Ventilate infant with bag-mask or NeoT to keep sats 88-95%, keep warm, start D10 and monitor glucoses and vitals
	* If the infant is apneic and requires intubation, prepare the tube~~, pre-oxygenate, intubate and confirm placement of tube by sound~~ and ~~by end-tidal CO2, etc.~~		*Many infants respond well to mask CPAP or High Flow (see HF guideline for Neonatal set up). In most infants greater than 27 weeks, this support may be enough for several hours.
	* ~~If a patient is intubated--be prepared to take turns bagging the baby back to Bethel.~~		*If the infant is apneic or has increasing respiratory compromise and requires intubation,
	* If the infant requires sedation prior to intubation or to maintain intubation, ~~you can~~ use morphine 0.~~1mg~~/kg.		**prepare the ET tube and equipment
	* ~~Tape~~ the tube securely in place with benzoin and pre-cut cloth tape (consider duaderm on skin to attach tape to). Neobars are not recommended.		**if the infant requires sedation prior to intubation or to maintain intubation, use morphine 0.05mg/kg.
	* If patient is < 30 wks ~~please~~ give Curosurf per neonatal resuscitation ~~sheet (link) dose and~~ Curosurf instructions (link) ~~DO NOT give >30 wk infants surfactant without Xray confirmation of RDS or consultation with NICU attending.~~		**intubate and confirm placement of tube by auscultation and end-tidal CO2.
	* If it is not possible to obtain a good IV ~~then it will be necessary to place a UVC~~ for labs/meds/fluids.		**tape the tube securely in place with benzoin and pre-cut cloth tape (consider duaderm on skin to attach tape to). Neobars are not recommended.
	* ~~UVC SETUP AND PLACEMENT (~~Keep set up sterile!)		**gently ventilate and increase support as needed using neonatal resuscitation guide as reference
	**Get out the kit, a stopcock, and normal saline to flush the catheter and stopcock.		*If a patient is intubated--be prepared to take turns manually ventilating the baby back to Bethel, as the ventilator is not good for use with neonates
	**-Sterilely prep and drape the umbilicus and drop in UVC line~~. Use the [[media:Neonatal_resuscitation_summary.pdf\|neonatal resuscitation sheet]] to determine apprx insertion depth. If baby is~~ in ~~a polyurethane bag…cut hole in bag~~ to ~~place catheter~~.		*If patient is < 30 wks give Curosurf per neonatal resuscitation guide, but remember there are times when it makes more sense to get an infant back to Bethel before giving curosurf. See Curosurf instructions (link)
	** When umbilical line is placed, use Tegaderm in 2 pieces around umbilicus and secure umbilical bridge to tagaderm. (Tegaderm may not stick to extremely premature skin (<24 wks GA)..		*UVC SETUP AND PLACEMENT will be needed if it is not possible to obtain a good IV for labs/meds/fluids.
	** Tape in ~~umbilical~~ line with goal post tape and/or use tagaderm over the top of line etc to secure it for transport.		**Keep set up and procedure '''sterile'''!
	* Bolus only with NS per ~~[[media:Neonatal_resuscitation_summary.pdf\|~~neonatal resuscitation ~~sheet]]~~.		**If baby is in a polyurethane bag…cut hole in bag to place catheter.
	* Use D10 for treatment of hypoglycemia per ~~[[media:Neonatal_resuscitation_summary.pdf\|~~neonatal resuscitation ~~sheet]] and as maintenance fluid as needed.~~		**Get out the UVC kit, a stopcock, and normal saline to flush the catheter and stopcock.
	* MAKE SURE TO KEEP THE BABY WARM! Cold babies do very badly.		**Sterilely prep and drape the umbilicus and drop UVC line in just far enough to get good blood return. When umbilical line is placed, use Tegaderm in 2 pieces around umbilicus and secure umbilical bridge to tagaderm. (Tegaderm may not stick to extremely premature skin (<24 wks GA)..
	* Be sure that you or ~~someone you~~ delegate has activated a neonatal Medevac from Anchorage to Bethel as soon as you know that the infant will require transport to Anchorage.		**Tape in Umbilical line with goal post tape and/or use tagaderm over the top of line etc to secure it for transport.
	* Remember that NICU docs are available for consultation 907 212-3614		**UAC line placement is not recommended in the village
			*Bolus only with NS per neonatal resuscitation guide.
			*Use D10 for treatment of hypoglycemia and maintenance fluid per neonatal resuscitation guide
			*MAKE SURE TO KEEP THE BABY WARM! Cold babies do very badly.
			*Be sure that you or a delegate has activated a neonatal Medevac from Anchorage to Bethel as soon as you know that the infant will require transport to Anchorage.
			*Remember that NICU docs are available for consultation 907-212-3614

	===When baby is stable and ready for transport===		===When baby is stable and ready for transport===