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http://projects.csail.mit.edu/courseware/?term=cassirer-essay-on-man cassirer essay on man 40). In most situations, there is no value to the administration of bicarbonate or other buffers during immediate resuscitation. Because there are potential risks as well as benefits for all medications (see table 5.3), drug administration through the umbilical vein should be reserved for those newborns in whom bradycardia persists despite adequate oxygen delivery and ventilation after establishment of an adequate airway. Once an adequate airway has been established, adequate ventilation achieved, and the heart rate exceeds 100 bpm, the infant should be moved to the neonatal intensive care unit (nicu), where physical examination, determination of vital signs, and test results, such as chest radiographic appearance, will more clearly identify needs for specific interventions. Iv. Reversal of narcorlc depression is rarely necessary during the primary steps of resuscitation and is not recommended. If the mother has received narcotic analgesia within a few hours of delivery, the newborn may manifest respiratory depression because of transplacental passage. The depression usually presents as apnea that persists even after bradycardia and cyanosis have been easily corrected with bag-and-mask ventilation. These infants should be treated with naloxone {0.4 mgl ml), in a dose of 0.25 ml/kg (e.G., 0.1 mg/kg). Naloxone should not be used if the mother is a chronic user of narcotics because of the risk of acute withdrawal in the infant. Respiratory support should be maintained until spontaneous respirations occur. ... 60 iv. I resuscitation in the delivery room special situations a. Meconium aspiration (see chap. 35) 1. In the presence of any meconium staining of the amniotic fluid, the obstetrician should quickly assess the infant during the birth process for the presence of secretions or copious amniotic fluid. Routine suctioning of all meconiumstained infants is not recommended, but in the presence of significant fluid or secretions, the mouth and pharynx should be aspirated with a bulb syringe after delivery of the head and before breathing begins.

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best thesis introduction Karner c, cates cj. Combination inhaled steroid and longacting beta2-agonist in addition to tiotropium versus tiotropium or combination alone for chronic obstructive pulmonary disease. Cochrane database syst rev. 2011;3:Cd008532. 31. Magnussen h, disse b, rodriguez-roisin r, et al. Withdrawal of inhaled glucocorticoids and exacerbations of copd. N engl j med. 2014;371:1285–1294. 32. Alpha-1 antitrypsin deficiency task force. American thoracic society/european respiratory society statement. Standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. Am j respir crit care med. 2003;168:818–900. 33. Usery jb, self th, muthiah mp, finch ck. Potential role of leukotriene modifiers in the treatment of chronic obstructive pulmonary disease. Pharmacotherapy. 2008;28:1183–1187. 34.

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