Precipitous Labor & Neonatal Resuscitation

This scenario starts in the emergency department. There is an obviously pregnant mom who is screaming in pain. The OB/GYN cannot arrive at the hospital in time, even if they are paged. Delivery becomes imminent, and the mom gives birth to a baby with a poor tone and low heart rate. The scenario fades from the imminent delivery to a baby warmer. If the learner follows proper NRP–first PPV, then intubation, then chest compressions and epinephrine–the baby recovers. If the learner fails to follow these steps, then the baby becomes pulseless and does not recover.

Learning Objectives

– Learner recognizes the absence of spontaneous respirations, following commands, and a 0/4 Train of Four
– Learner verbalizes suspected PchE deficiency
– Learner turns anesthesia gas back on and increases ventilator control settings
– Learner recognizes the signs that the patient is ready to be extubated
– Extubates based on the American Society of Anesthesiology Extubation Criteria