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Jste voláni jako RLP posádka za město, kde je již na místě PČR, hlásí přítomnost ženy, bezdomovkyně, krátce po porodu. Novorozeně se jeví donošené, je podchlazené, nepláče, AS 80/min, dechová aktivita nepravidelná, bradypnoe, na bolestivý podnět bez pohybu končetin, pouze grimasa, tělíčko bledé, centrální cyanoza. Matka je agresivní, odmítá jakoukoliv péči či komunikaci s vámi…. Váš postup stran novorozence?
Řešení:
U novorozence nejprve zajistíme : osušení, teplotní komfort, pozici podložením lopatek rouškou, stimulaci ( a ev.při aspiraci mekonia odsátí úst a nosu. )
Souběžně následuje hodnocení třech nejdůležitějších prvků, a to dechové aktivity, akce srdeční a barvy. ( Apgar score navíc ještě hodnotí svalový tonus a reflexní aktivitu).
Dle toho pak mohou nastat následující situace:
1) TF nad 100/min, norm.dechová aktivita, růžová barva kůže: pokračujeme v observaci novorozence.
2) TF nad 100/min, abnormální dechová aktivita, cyanoza: provádíme stimulaci, ventilaci maskou , bráníme hypotermii… jen připomínám,při ventilaci novorozence maskou déle než 2 minuty, zvážíme buď zavedení ŽS k odsátí vzduchu ze žaludku nebo OTI.
3) TF pod 100/min, abnormální dechová aktivita, neúspěšná ventilační podpora maskou: OTI, kanyla vel.3,0 – 3,5 – 4, UPV, zvážíme zajištění nitrožilního vstupu.
4) TF pod 60/min : zahájíme nepřímou srdení masáž, dvěma palci, v poměru 90:30 ( během 1 sekundy tři stlačení, během druhé sekundy 1 vdech ), zajištění nitrožilního vstupu ( umbilikální žíla, periferní žíla, intraosseální vstup), nedostaví-li se efekt do 30 sekund, zahájíme farmakoterapii.
Dávkování některých farmak:
-adrenalin 1:10 000 0,01-0,03 mg/kg iv (odtáhneme 0,2mg adrenalinu 1:1000 , doplníme do 2 ml , podáme 1ml )
-krystaloid 10 ml/kg iv
-Glu 10% 2-4 ml/kg iv.
-dopamin 5-20 ug/kg/min kont.iv.
-naloxon 0,1 mg/kg iv. 
nedojde-li k obnovení oběhu ani přes adekvátně prováděnou resuscitaci do 10 minut, lze KPCR ukončit.

V našem případě byl novorozence podchlazený, TF 80/min, nedostatečná dechová aktivita, cyanoza. Prioritou je tedy přenést dítě do vyhřáté sanity, zajistit tepelný komfort, stimulovat a ventilovat maskou. Pokud by nedošlo ke zvýšení TF a normalizace dechové aktivity do cca 2 minut , měly by být dechové cesty zajištěny OTI kanylou. Současně zajištěn žilní vstup, zahájena volumoterapie, korekce hypotermie, kontrola ošetření pupečníku, celkové fyzikální vyšetření a monitorace. Transport na neonatologické odd. Matka , odmítá-li vyšetření a spolupráci, předána do péče PČR.

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