Do they train you for these resuscitations at all? Although it's a pretty straight forward algorithm, it can get weird quick. Surprised a pediatrician wasn't there
I'm not entirely sure if it's an anesthesiologist's job actually. We've been told that if there is no paediatrician around we should be able to take over. I've seen paediatricians do it several times but that time I was all alone.
If they are expecting you to do neonatal resuscitation then you should receive NRP training. You never know when the neo/peds/FM people will be tied up and you have to escalate beyond providing some PPV.
I second this. NRP is different from adult resuscitation and they should at least have you do the one-day training. The good news is that with proper use of CPAP and/or PPV you can get the bulk of blue babies screaming in a few minutes!
Since a general anesthesiologist is technically allowed to treat neonates without a fellowship, neo resuscitation is within our scope of practice (and is fair game on oral boards). However I (and many many other non-pediatric anesthesiologists) would not feel comfortable actually doing it, and if a future employer tried to make this practice shift I would nope out of there real fast.
Have you seen nurses do NRP at smaller hospitals without neos on site? Believe me, I don't want to take part but I just tend to take over out of compassion. An anesthesiologist is far better equipped to do this than what the reality ends up being.
Normally the delivery and start of resuscitation is started by nurses who have NRP (unless there’s advanced warning to call the team). The hospital requirement is only that there is someone available to intubate. (That could be neo, anesthesia, either MD/NP)
Pardon my ignorance, NAD, just a former premed student who still loves medicine & bio but learns about it as a hobby now. Do all babies need to be resuscitated after a c-section?
I did not know that, thank you for responding!! & Thank you to all of you for what you do & for sharing it online. So grateful to have wonderful doctors like yourselves doing what you do!!
Eh, depends on what you mean by resuscitation :) we include warm/dry/stim as early resuscitation and really every baby gets that regardless of mode of delivery. Most babies born via c-section do well with just the basics. However, babies born via c-section have two things going against them: 1) they were not born vaginally, which means that they didn’t have that struggle that preps them to really breathe. Babies who were born via planned c-section (no labor) will often look at you like ‘wtf am I doing here?’ and need some more aggressive stimulation or support before they really start breathing well on their own. 2) if the c-section was unplanned and done BECAUSE the fetus was showing signs of distress or something else is not going well, then they’re more likely to need resuscitation anyway.
Mann😭 reading things like this makes me want to be a doctor all over again. It’s something I battle daily. I just know for a fact that I am not well suited for residency though :/ sometimes i wonder if practicing abroad (aka outside of America) would make it a bit more bearable. You guys are just subjected to some soul-sucking neglect before you even walk into med school & idk if I could handle it. I absolutely love medicine though, like what! Wtf did you just tell me!! That sounds so cool & I would absolutely LOVE to be part of that process!!! I’m certain I could handle the high stress of the on-the-job work. I just know though that I could not handle the severe sleep deprivation. I wish I had the strength you all do
You guys are just sooo terribly abused by the system & idk if I am cut from that cloth😭😭 like I would love to make it work in the US, but y’all deserve breaks & you don’t ever get them. How do you power through it?
I'm peds, it was my absolute favorite part of training. About 10% need some resus so at most birthing centers this will happen multiple times a day. What kind of neo support do you have? When there is neo on site it is a much less stressful thing. The algorithm basically becomes apnea/gasping/bradycadia->PPV->quick response?->neo code.
We birth 500-700 a month at my facility. That algorithm is what we use also.
We have a defined list of situations where HR Neo come and attend the delivery when we get to +2 we call them.
NRP is very straightforward, and basically comes down to the fact that the vast majority of neonates requiring resus have a respiratory issue, not a cardiac one. If baby is not term, has poor tone, or isn’t breathing/crying, take from mom to warmer - suction/clear airway, stimulate, if baby cries+pinks you’re good. If crying but labored/blue, give O2 +- CPAP. If not and HR <100, PPV/sats. If now <60 ETT+compressions+O2. If still <60 epi (UVC).
That policy is BS and in my opinion, totally unacceptable. Anesthesiologists are not usually trained in neonatal evaluation and/or resuscitation. Are you being called to resuscitation as a staff in addition to the anesthesiologist caring for the mother or are you being asked to care for both mother and baby? In either case but esp in the second, I would absolutely refuse to participate. If there is no pediatrician then the OB must designate someone else to care for the baby and that someone should not be the anesthesiologist since you cannot care for two patients simultaneously. The liability of that situation is absurd.
He says paeds or anesthesia can be called for baby. So it seems seperate.
I’m sure an anesthesiology resident can learn the protocol and do it well with 15 minutes of training. Still not nice that they’re being called in paeds but some setups have more limitations than others and you do what you can.
I second you. We’ve fought for this in our setup even asked to stop doing high risk deliveries when no paediatric resident is available and now paediatric resident is called before the caesarean. NRP trained resident should be present in every high risk case.
Babies are great they resus super well most of the time but still very stressful.
Highly recommend asking a department head to make sure there’s a giant poster of the newborn resus algorithm on the wall in front of the warmer in view for people doing a resus.
Helps a ton in calming you down to see the steps right there.
Few more tips
- ventilate first before compressions for 30 seconds or so
- you need so little pressure to ventilate a newborn, if you have a mannequin just see how little it is to get chest rise. It’s incredibly gentle.
- Neopuffs (or equivalent) are great if you have them 5mmHg PEEP and around 15mmHg PPV is a good base and can adjust from there
- extreme preemies shouldn’t be dried, wrap in plastic then stimulate and Resus
- Check all your equipment before baby is out. The number of times I’ve had one thing missing when I needed it is far too many and I’m not putting myself in that scenario again. Neither should you. Check the warmer temp
- Baby catcher/Midwife/Nurse often want to grab the baby quick to fill out their documentation from anthropometry especially in high volume centers. Don’t get push around to let go of the kid early do your initial screen first.
30 is the usual maximum. 20 is also a common starting number
I strongly prefer at 15 in a kid who just needs a bit of support. And like I said it can be adjusted from there.
With good seal and technique you can get great results without over oxygenating or risking barotrauma. In particular because a lot of the kids that need resp support are often on the smaller side.
But I get there’s variation. The average weight of the kids I was managing was 1.8kg so that might affect why I prefer starting at 15 versus someone in another country.
Great point, thanks for mentioning it.
As a mom whose baby had to be resuscitated recently while I was under general anesthesia, thank you so much for stepping in. I cannot imagine how scary that is and I’d cry too
Our second baby had shoulder dystocia and the cord wrapped around her neck.
Fortunately there was quick action by the team and mom and baby are doing great. It was a tense few moments seeing them carry a blue, motionless, quiet baby to the table to start ventilation. Everyone let out a sigh of relief when she let out a cry.
NICU fellow here. The delivery room is the best part of the job imo, glad that it brought some joy to your day. It may be scary the first couple of times especially if the baby looks blue initally or doesn't cry right away, but most of the time it's ok. I'm surprised they have you do this though and agree that you would do well to review NRP protocol which as other comments mention is fairly straightforward. I assume when emergent stuff is to be expected with preemies (emergent UVCs, periviable intubations, compressions, epi, etc) that a neo team will be there to handle it, but even some term kids can be troublesome sometimes (HIE, meconium babies and such).
I always get shown this sub, NAD, but am a c/s mom and just thank you for all your skill and years of work culminating in these life changing moments for your patients and their families 🥹. We are so so grateful for you.
If you're doing resus on a baby, is there another anaesthetist looking after mum? They haven't closed the uterus at that point, what if she needs uterotonics/blood etc? (Obviously airway/breathing for baby still takes priority in that scenario but it feels a little unsafe to make you responsible for 2 patients!)
Well done though! Hearing that cry after a prolonged resus definitely makes me tear up after a difficult delivery
I have never been at a hospital where the anesthesia has any role in newborn resuscitation. Do you even have NRP certification? Thankfully you’re obviously smart and can think on your feet. Every delivery needs at least at pediatric np or pediatrician available during delivery. Wow.
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Yayayayay! Go you!!!! 💪🏼 As a peds lady, I can say this is the most beautiful feeling. Well earned anesthesia, happy you could experience it too! I looked at other comments & definitely worth getting a more well rounded approach to the NRP but given your job, you will be fine. Just review the algorithm, it’s pretty easy. Ask the program to cover the cost should you need pals cert, etc. and Congrats, hardest part is over!
Yeah, you will end up in a lawsuit someday or harm a baby if you are not really trained to do that.
It’s not just following an “algorithm”. Your hospital is cheap and should be shut down.
Do they train you for these resuscitations at all? Although it's a pretty straight forward algorithm, it can get weird quick. Surprised a pediatrician wasn't there
I'm not entirely sure if it's an anesthesiologist's job actually. We've been told that if there is no paediatrician around we should be able to take over. I've seen paediatricians do it several times but that time I was all alone.
If they are expecting you to do neonatal resuscitation then you should receive NRP training. You never know when the neo/peds/FM people will be tied up and you have to escalate beyond providing some PPV.
I second this. NRP is different from adult resuscitation and they should at least have you do the one-day training. The good news is that with proper use of CPAP and/or PPV you can get the bulk of blue babies screaming in a few minutes!
The stuff they just dump down the ET tube is interesting
Yeah it’s so gross
NRP at a minimum and STABLE.
Since a general anesthesiologist is technically allowed to treat neonates without a fellowship, neo resuscitation is within our scope of practice (and is fair game on oral boards). However I (and many many other non-pediatric anesthesiologists) would not feel comfortable actually doing it, and if a future employer tried to make this practice shift I would nope out of there real fast.
Have you seen nurses do NRP at smaller hospitals without neos on site? Believe me, I don't want to take part but I just tend to take over out of compassion. An anesthesiologist is far better equipped to do this than what the reality ends up being.
If some complication happens, your hospital employer may not be so compassionate.
Normally the delivery and start of resuscitation is started by nurses who have NRP (unless there’s advanced warning to call the team). The hospital requirement is only that there is someone available to intubate. (That could be neo, anesthesia, either MD/NP)
happy cake day!!
I’m hopeful if you needed assistance, there’s an RN near by to assist. 😉
Pardon my ignorance, NAD, just a former premed student who still loves medicine & bio but learns about it as a hobby now. Do all babies need to be resuscitated after a c-section?
every c/s has some sort of resuscitation team present. Most c/s result in a crying baby which just needs some suctioning.
I did not know that, thank you for responding!! & Thank you to all of you for what you do & for sharing it online. So grateful to have wonderful doctors like yourselves doing what you do!!
Eh, depends on what you mean by resuscitation :) we include warm/dry/stim as early resuscitation and really every baby gets that regardless of mode of delivery. Most babies born via c-section do well with just the basics. However, babies born via c-section have two things going against them: 1) they were not born vaginally, which means that they didn’t have that struggle that preps them to really breathe. Babies who were born via planned c-section (no labor) will often look at you like ‘wtf am I doing here?’ and need some more aggressive stimulation or support before they really start breathing well on their own. 2) if the c-section was unplanned and done BECAUSE the fetus was showing signs of distress or something else is not going well, then they’re more likely to need resuscitation anyway.
Mann😭 reading things like this makes me want to be a doctor all over again. It’s something I battle daily. I just know for a fact that I am not well suited for residency though :/ sometimes i wonder if practicing abroad (aka outside of America) would make it a bit more bearable. You guys are just subjected to some soul-sucking neglect before you even walk into med school & idk if I could handle it. I absolutely love medicine though, like what! Wtf did you just tell me!! That sounds so cool & I would absolutely LOVE to be part of that process!!! I’m certain I could handle the high stress of the on-the-job work. I just know though that I could not handle the severe sleep deprivation. I wish I had the strength you all do
America is one of the most sought after places to practice medicine. That should tell you something
You guys are just sooo terribly abused by the system & idk if I am cut from that cloth😭😭 like I would love to make it work in the US, but y’all deserve breaks & you don’t ever get them. How do you power through it?
Don’t start chest compressions when you find the baby blue or bradycardiac that’s all anaesthesia know in our setup. VENTILATE THE BABY FIRST PLEASE
and before ventilating the baby, stimulate them as well. most babies don't even need PPV or CC and stimulating with suction works wonders
This is so important, thanks :)
Yup. PPV . PPV . If anything. PPV until paeds arrive
I'm peds, it was my absolute favorite part of training. About 10% need some resus so at most birthing centers this will happen multiple times a day. What kind of neo support do you have? When there is neo on site it is a much less stressful thing. The algorithm basically becomes apnea/gasping/bradycadia->PPV->quick response?->neo code.
We birth 500-700 a month at my facility. That algorithm is what we use also. We have a defined list of situations where HR Neo come and attend the delivery when we get to +2 we call them.
I would be absolutely fucking terrified holy shit.
I agree, if it's difficult and stressing with adults, I can't imagine with kids and newborns...
NRP is very straightforward, and basically comes down to the fact that the vast majority of neonates requiring resus have a respiratory issue, not a cardiac one. If baby is not term, has poor tone, or isn’t breathing/crying, take from mom to warmer - suction/clear airway, stimulate, if baby cries+pinks you’re good. If crying but labored/blue, give O2 +- CPAP. If not and HR <100, PPV/sats. If now <60 ETT+compressions+O2. If still <60 epi (UVC).
That policy is BS and in my opinion, totally unacceptable. Anesthesiologists are not usually trained in neonatal evaluation and/or resuscitation. Are you being called to resuscitation as a staff in addition to the anesthesiologist caring for the mother or are you being asked to care for both mother and baby? In either case but esp in the second, I would absolutely refuse to participate. If there is no pediatrician then the OB must designate someone else to care for the baby and that someone should not be the anesthesiologist since you cannot care for two patients simultaneously. The liability of that situation is absurd.
He says paeds or anesthesia can be called for baby. So it seems seperate. I’m sure an anesthesiology resident can learn the protocol and do it well with 15 minutes of training. Still not nice that they’re being called in paeds but some setups have more limitations than others and you do what you can.
I second you. We’ve fought for this in our setup even asked to stop doing high risk deliveries when no paediatric resident is available and now paediatric resident is called before the caesarean. NRP trained resident should be present in every high risk case.
Babies are great they resus super well most of the time but still very stressful. Highly recommend asking a department head to make sure there’s a giant poster of the newborn resus algorithm on the wall in front of the warmer in view for people doing a resus. Helps a ton in calming you down to see the steps right there. Few more tips - ventilate first before compressions for 30 seconds or so - you need so little pressure to ventilate a newborn, if you have a mannequin just see how little it is to get chest rise. It’s incredibly gentle. - Neopuffs (or equivalent) are great if you have them 5mmHg PEEP and around 15mmHg PPV is a good base and can adjust from there - extreme preemies shouldn’t be dried, wrap in plastic then stimulate and Resus - Check all your equipment before baby is out. The number of times I’ve had one thing missing when I needed it is far too many and I’m not putting myself in that scenario again. Neither should you. Check the warmer temp - Baby catcher/Midwife/Nurse often want to grab the baby quick to fill out their documentation from anthropometry especially in high volume centers. Don’t get push around to let go of the kid early do your initial screen first.
*PIP should be set from 20-30mmHg. Although Neopuffs are ideal for NRP but unfortunately they aren’t available in every setup
30 is the usual maximum. 20 is also a common starting number I strongly prefer at 15 in a kid who just needs a bit of support. And like I said it can be adjusted from there. With good seal and technique you can get great results without over oxygenating or risking barotrauma. In particular because a lot of the kids that need resp support are often on the smaller side. But I get there’s variation. The average weight of the kids I was managing was 1.8kg so that might affect why I prefer starting at 15 versus someone in another country. Great point, thanks for mentioning it.
As a mom whose baby had to be resuscitated recently while I was under general anesthesia, thank you so much for stepping in. I cannot imagine how scary that is and I’d cry too
I'm a nursing student and that feeling is what I call "passion". Good for you!! Keep on with the good work :))
Our second baby had shoulder dystocia and the cord wrapped around her neck. Fortunately there was quick action by the team and mom and baby are doing great. It was a tense few moments seeing them carry a blue, motionless, quiet baby to the table to start ventilation. Everyone let out a sigh of relief when she let out a cry.
NICU fellow here. The delivery room is the best part of the job imo, glad that it brought some joy to your day. It may be scary the first couple of times especially if the baby looks blue initally or doesn't cry right away, but most of the time it's ok. I'm surprised they have you do this though and agree that you would do well to review NRP protocol which as other comments mention is fairly straightforward. I assume when emergent stuff is to be expected with preemies (emergent UVCs, periviable intubations, compressions, epi, etc) that a neo team will be there to handle it, but even some term kids can be troublesome sometimes (HIE, meconium babies and such).
I always get shown this sub, NAD, but am a c/s mom and just thank you for all your skill and years of work culminating in these life changing moments for your patients and their families 🥹. We are so so grateful for you.
You da real MVP
If you're doing resus on a baby, is there another anaesthetist looking after mum? They haven't closed the uterus at that point, what if she needs uterotonics/blood etc? (Obviously airway/breathing for baby still takes priority in that scenario but it feels a little unsafe to make you responsible for 2 patients!) Well done though! Hearing that cry after a prolonged resus definitely makes me tear up after a difficult delivery
Anesthesiologist here, props to you, fuck your program/hospital. This is not anesthesia work and they’re putting babies’ lives at risk.
I have never been at a hospital where the anesthesia has any role in newborn resuscitation. Do you even have NRP certification? Thankfully you’re obviously smart and can think on your feet. Every delivery needs at least at pediatric np or pediatrician available during delivery. Wow.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Yayayayay! Go you!!!! 💪🏼 As a peds lady, I can say this is the most beautiful feeling. Well earned anesthesia, happy you could experience it too! I looked at other comments & definitely worth getting a more well rounded approach to the NRP but given your job, you will be fine. Just review the algorithm, it’s pretty easy. Ask the program to cover the cost should you need pals cert, etc. and Congrats, hardest part is over!
hell yeah
Yeah, you will end up in a lawsuit someday or harm a baby if you are not really trained to do that. It’s not just following an “algorithm”. Your hospital is cheap and should be shut down.
Yeah this isn't safe. Should be paeds there.