APGAR Scoring

excalibur

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5 components, which are graded 0 to 2. They are HR, Respiratory effort, muscle tone, reflex irritability, color (Barash table 42-4 in obstetric anesthesia chapter)
ACRONYM: SHIRT. S: Skin Color, H: HR, I: Irritability, R: Resp Rate, T: Tone

HR
0: Absent
1: < 100 beats/min
2: > 100 beats/min

Respiratory effort
0: Absent
1: Slow, irregular
2: Good, crying

Muscle tone
0: Limp
1: Some flexion of extremities
2: Active motion

Reflex irritability
0: No response
1: Grimace
2: Cough, sneeze, or cry

Color
0: Pale, blue
1: Body pink, extremities blue
2: Completely pink
 
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excalibur

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Along with this goes resuscitation of the newborn...(Barash figiure 42-15 in obstetric anesthesia chapter)

Immediately after birth, the newborn should be
1. Placed supine under a radiant heater
2. Dried thouroughly
3. Wet linen removed
4. Position the head low with a slight lateral tilt
4. Suction Mouth, then Nose (Suction Trachea if thick meconium is noted or in the drepressed newborn)--No more than 30 secs
5. Provide Tactile Stimulation (Slapping the soles)

At this point respirations should be evaluated
-If patient has spontaneous respirations, eval HR. If HR > 100, eval color. If color pink, observe...If color blue provide O2
-If on initial eval pt has no respirations or his HR is less than 100, provide PPV for 15-30 secs. If respiratory depression is believed to be drug induced, give Narcan (0.1 mg/kg IV, IM, SC, or by ETT)
-After 15-30 secs of PPV, eval HR while continuing to bag
-If HR > 100, await for spontaneous respirations and then discontinue PPV and move on to evaluating color.
-If HR is between 60-100...If HR is increasing just continue PPV, if HR is not increasing commence chest compressions with PPV (3:1 or 100 compressions to 30 breaths) especially if HR < 80.
-If HR < 60...commence chest compressions and PPV (3:1 or 100 compressions to 30 breaths) for 30 secs
-If after 30 secs of compressions and PPV, HR remains below 30 bpm, initiate medications (epinephrine 0.1 to 0.3 mL/kg of a 1:10,000 solution IV or b ETT--repeat every 5 mins if necessary)
 
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