ValleyProtocolBook

The Valley Hospital Emergency Services

6

Standing Orders / Communications Failure Orders

8. If no change, administer a fluid bolus of 10 mL/kg of normal saline over five (5) to ten (10) minutes;

9. Determine blood glucose;

(i) If equal to or greater than 40, contact medical command; and

(ii) If less than 40, administer 0.5 g/kg (5 mL/kg) of a 10 percent dextrose solution, contact medical command.

Communications Failure Orders for neonatal resuscitation

a) Continue administration of epinephrine 1:10,000 0.01 mg/kg via vascular access every three to five minutes as long as chest compressions are being provided. b) If ventricular fibrillation or ventricular tachycardia is present, defibrillate at 2 J/kg.

a. If ventricular fibrillation persists, provide additional shocks every two minutes at 4 J/kg and;

b. Administer Amiodarone 5 mg/kg via vascular access once

c) Repeat administration of a fluid bolus of 10mL/kg of normal saline over five (5) to ten (10) minutes to a maximum of 30mL/kg.

d) If mother is suspected to have been under the influence of opiate or opioid narcotics, administer Naloxone 0.1mg/kg to a maximum of 2mg via vascular access.

e) If chest compressions have been administered for longer than five minutes, administer Sodium Bicarbonate 4.2% 1 mEq/kg to a maximum of 10 mEq/kg via vascular access.

f) During re-assessments, if patient has a heart rate greater than 60 beats per minute, stop CPR and continue positive pressure ventilation.

g) During re-assessments, if patient has a heart rate greater than 100 beats per minute, assess respiratory effort;

a. If effort is inadequate, continue positive pressure ventilation.

b. If effort is adequate, provide supplemental oxygen