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Learning Objectives:
- Recognize and manage asphyxia in a newborn.
- Perform neonatal resuscitation following established guidelines.
- Understand the importance of early intervention to prevent complications.
Scenario Setup:
- Gestational Age: 36 weeks,
- Birth Weight: 3800 grams
- Condition: Apgar score of 0 at 1 minute, requiring immediate resuscitation.
Required Roles:
- Lead Resuscitator : Doctor or experienced nurse
- Airway Manager : Responsible for intubation and airway management
- Ventilation Technician : Manages mask-bag ventilation
- Assistant : Performs chest compressions and monitors heart rate
- Family Liaison : Communicates with the family (optional)
Equipment Needed:
- Neonatal resuscitation unit (mask, bag, oxygen supply)
- Intubation equipment
- Heart rate and oxygen saturation monitors
- Medication: epinephrine, glucose IV
- Simulation mannequin (newborn)
Steps:
1. Initial assessment: Newborn shows no signs of breathing, Apgar score of 0.
2. Start with mask-bag ventilation and monitor heart rate.
3. Begin chest compressions if heart rate remains low.
4. Perform intubation and continue ventilation.
5. Administer epinephrine and fluids if required.
6. Stabilize the newborn, monitor heart rate (>100 bpm), and respiratory effort.
Blood Gases & Lactate:
- pH : 6.9 (severe metabolic and respiratory acidosis)
- PaCO2 : 70 mmHg (elevated due to respiratory failure)
- PaO2 : 30 - 40 mmHg (severe hypoxemia)
- HCO3- : 10 - 15 mmol/L (metabolic acidosis due to poor perfusion)
- Base Excess (BE) : -20 mmol/L
- Lactate : 12 mmol/L (indicating anaerobic metabolism and hypoxia)
Debriefing Points:
- What went well during the resuscitation?
- How could communication and role allocation have been improved?
- Discuss the importance of timing in resuscitation (ventilation, compressions, intubation).
- Reinforce the importance of teamwork and structured communication
Learning Objectives:
- Recognize and manage pulmonary hypertension in a newborn.
- Adjust ventilator settings to optimize oxygenation and reduce strain on the heart.
- Set up iv treatment.
Scenario Setup:
- Gestational Age: 36 weeks
- FiO2: 0.8 with SaO2 of 70% (foot), 88% (right hand)
- Complication: Pulmonary hypertension, requiring respiratory support.
Required Roles:
- Ventilator Specialist : Adjusts PEEP, PIP, and monitors ventilator settings
- Lead Doctor : Oversees care and directs team
- Nurse : Manages glucose IV, administers antibiotics
- Nurse : Tracks SpO2, heart rate, and glucose levels, documentation
- Family Liaison : Communicates with the family (optional)
Equipment Needed:
- Neonatal ventilator
- Glucose, fluids and inotrope IV administration set
- High-frequency ventilator (HFV) setup
- Oxygen saturation and heart rate monitors
-Arterial line (UAC) for blood pressure and blood sampling
- Antibiotics,glucose, inotrope and IV administration
Steps:
1. Set initial ventilator parameters: FiO2, PEEP, PIP.
2. Monitor SpO2 and adjust settings to improve oxygenation (consider HFV).
3. Set up umbilical and peripheral venous access and administer inotropes (if needed), IV glucose and antibiotics for infection management.
4. Perform chest X-ray to assess lung status.
5. Continuously monitor vital signs (SpO2, blood glucose, heart rate).
Blood Gases & Lactate:
- pH : 7.25 - 7.30 (mild metabolic acidosis with a component of respiratory acidosis)
- PaCO2 : 55 - 65 mmHg (improving but still elevated due to hypoventilation)
- PaO2 : 45 - 55 mmHg (moderate hypoxemia despite FiO2 0.8)
- HCO3- : 18 - 22 mmol/L (compensation for metabolic acidosis)
- Base Excess (BE) : -6 to -10 mmol/L
- Lactate : 5 - 8 mmol/L (elevated, but improving with treatment)
Debriefing Points:
- Discuss the team’s approach to adjusting ventilator settings.
- How was the decision made to intensify respiratory support?
- Review the importance of continuous monitoring and adjusting support based on real-time data.
- Discuss any communication challenges or successes in managing pulmonary hypertension.
Learning Objectives: - Identify the signs and symptoms of pneumothorax in a newborn. - Perform emergency thoracic drainage to relieve pressure on the lungs. - Coordinate team response during respiratory emergencies. Scenario Setup: - Gestational Age: 36 weeks - Condition: Sudden drop in SpO2 to 70%, decreased tidal volumes on the ventilator. - Complication: Suspected pneumothorax. Required Roles: - Lead Doctor : Diagnoses pneumothorax and directs team, inserts chest drain - Nurse : Monitors tidal volumes and ventilator settings - Nurse : Assists with chest drain setup and monitors vital signs - Family Liaison : Communicates with the family (optional) Equipment Needed: - Chest drain insertion kit - Light for transillumination ;xrau;ultrasound (optional) - Ventilator with PEEP and PIP settings - Oxygen saturation and heart rate monitors Steps: 1. Recognize clinical signs of pneumothorax (sudden drop in SpO2, small tidal volumes). 2. Confirm pneumothorax with chest X-ray or clinical signs. 3. Insert a thoracic drain to relieve the pressure. 4. Adjust ventilator settings post-drain insertion to stabilize lung function. 5. Monitor oxygenation and lung expansion. Blood Gases & Lactate: - pH : 7.10 - 7.20 (respiratory acidosis due to decreased ventilation) - PaCO2 : 70 - 80 mmHg (high due to impaired CO2 removal) - PaO2 : 30 - 40 mmHg (severe hypoxemia) - HCO3- : 18 - 20 mmol/L (compensation ongoing but insufficient) - Base Excess (BE) : -8 to -12 mmol/L - Lactate : 7 - 10 mmol/L (elevated due to acute respiratory compromise) Debriefing Points: - How quickly was the pneumothorax diagnosed and treated? - Was communication clear and timely during the emergency response? - Discuss the importance of recognizing subtle signs of deterioration. - Evaluate teamwork and coordination during the thoracic drain insertion.
Learning Objectives:
- Recognize and manage circulatory failure in a newborn with sepsis.
- Administer fluids and inotropes (dopamine) to support blood pressure and circulation.
- Ensure effective team coordination in managing neonatal shock.
Scenario Setup:
- Gestational Age: 36 weeks
- Condition: Blood pressure drop and poor circulation due to sepsis.
- Complication: Circulatory failure.
Required Roles:
- Lead Doctor : Oversees fluid and inotrope administration
- Nurse : Manages fluid therapy and monitors vitals,Tracks blood pressure, heart rate, and circulation status
- Nurse : Prepares and administers dopamine
- Family Liaison : Communicates with the family (optional)
Equipment Needed:
- IV fluids and dopamine administration set
- Blood pressure and heart rate monitors
- Syringe pump for dopamine infusion
- Oxygen saturation monitor
Steps:
1. Identify signs of circulatory failure (hypotension, poor perfusion).
2. Administer IV fluids to improve circulation.
3. Start dopamine infusion to stabilize blood pressure.
4. Monitor blood pressure, heart rate, and response to treatment.
5. Continue to manage the underlying sepsis with antibiotics and supportive care.
Blood Gases & Lactate:
- pH : 7.05 - 7.15 (severe metabolic acidosis with a respiratory component)
- PaCO2 : 50 - 60 mmHg (partially compensated respiratory acidosis)
- PaO2 : 45 - 55 mmHg ((moderate hypoxemia despite support)
- HCO3-: 10 - 15 mmol/L (metabolic acidosis due to shock)
- Base Excess (BE): -12 to -18 mmol/L
- Lactate: 10 - 15 mmol/L (severe lactic acidosis due to hypoperfusion)
Debriefing Points:
• Discuss the team’s response to circulatory failure.
• How effectively were fluids and inotropes administered?
• Review any challenges in maintaining communication and coordination during treatment.
• Emphasize the importance of early recognition and intervention in sepsis-related circulatory failure.
Objective
To train nurses and doctors in effectively admitting and providing care for very preterm babies (at or above 25 weeks gestation). This scenario will include initial stabilization practices and highlight the importance of the “Golden Hour” in neonatal care.
Learning Goals
1. Understand the critical needs of very premature babies, especially during the first hour of life (Golden Hour).
2. Develop competence in immediate clinical actions to stabilize vital functions, including respiratory, cardiovascular, and temperature control.
3. Apply decision-making frameworks for initiating intensive care vs. palliative care when necessary.
Materials and Equipment
• Simulation Manikin: Neonatal model capable of simulating respiratory distress, bradycardia, and responsive to interventions.
• NICU Equipment: Incubator, CPAP machine, ventilator, suction device, heart rate and oxygen saturation monitors, thermometers, and IV setup.
• Umbilical Catheterization Kit: Catheters, sterile gloves, drapes, antiseptic solution, saline flushes, and securing materials.
• PPE: Personal Protective Equipment (gloves, gowns, masks, eye protection).
• Documentation: Admission, stabilization, and procedural forms for umbilical catheter placement.
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Scenario Outline and Phases
1. Pre-Scenario Briefing (10 minutes)
o Audience: Nurses and doctors, organized in interdisciplinary teams.
o Brief: Overview of a very preterm infant in respiratory distress requiring immediate stabilization and vascular access.
o Roles: Assign roles such as lead clinician, respiratory support, umbilical catheterization nurse, and documentation assistant.
2. Simulation Phases
o Phase 1: Initial Assessment and Warming (5 minutes)
Objective: Ensure thermal stability and assess the baby’s physical condition.
Actions:
Pre-warm the incubator and wrap the baby in a plastic wrap or warm blanket.
Quickly assess appearance, tone, and initial respiratory effort.
Skills Practiced: Thermal management and initial assessment techniques.
o Phase 2: Airway Management and Respiratory Support (10 minutes)
Objective: Provide adequate ventilation to stabilize the infant’s respiratory status.
Actions:
Begin with CPAP if the baby has spontaneous but weak breathing.
Prepare for intubation if severe respiratory distress is noted.
Monitor oxygen saturation and adjust levels as needed.
Skills Practiced: CPAP setup, oxygen adjustment, and endotracheal intubation if required.
o Phase 3: Cardiovascular Support and Monitoring (5 minutes)
Objective: Establish stable heart rate and blood pressur
Actions : Simulate bradycardia or hypotension and prompt appropriate responses.
Begin chest compressions if necessary, and provide IV fluids.
Skills Practiced: Chest compressions, vascular access, and medication administration.
o Phase 4: Umbilical Catheter Placement (10 minutes)
Objective: Obtain vascular access for fluid administration, medication, and monitoring.
Actions:
Demonstrate aseptic technique and preparation of umbilical catheterization.
Guide participants through steps: cleaning, identifying insertion site, advancing the catheter, and securing it properly.
Practice saline flushing to confirm catheter patency and proper placement.
Skills Practiced: Aseptic technique, catheter insertion, securing, and flushing.
o Phase 5: Decision-Making and Ethical Considerations (5 minutes)
Objective: Address ethical considerations, such as the decision to continue intensive vs. palliative care.
Actions:
Present a simulated scenario where survival and quality of life are uncertain.
Encourage the team to discuss care options and consider family input.
Skills Practiced: Team communication, ethical judgment, and family-centered care.7
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Expected Outcomes
1. Increased proficiency in stabilizing preterm infants, including skillful placement of umbilical catheters.
2. Improved teamwork, communication, and ethical decision-making under high-stress conditions.
3. Enhanced understanding of cultural and family-centered care in the context of neonatal intensive care.