A neonate on bag and mask ventilation in cardio pulmonary resuscitation. The heart rate is 60-100 perminute. Next treatment is

(Stop chest compressions and continue ventilation) (99-0.P. Ghai 7th)Indications of chest compressions are absence of signs of circulation after delivering rescue breaths (no spontaneous breathing, coughing, movment or pulse)Child is pale or cyanosedHeart rate / pulse rate < 60 beats per minute with signs of poor perfusion after rescue breathsChest compressions provide circulation as a result of increase in intrathoracic pressure and / or directed compression of the heart and should be provided with ventilation in infants and children at a rate at least 100 compressions per minute in infants and 80 per minute in childrenBag and Mask ventilation - for full term neonates, infants and children <8 years of age, ventilation bags of minimum volume 450-500 ml should be used to deliver adequate amount of tidal volume. Neonatal size bags (250ml) may be useful for preterm neonatesSellick Maneuver (Compression of the cricoid cartilage backward, compressing the esophagus against the vertebral column) should be used to prevent aspiration of gastric contents* If ventilation and chest compression do not restore the circulation and spontaneous respiration, medications may be needed. If there is ECG evidence of potentially perfusing rhythm. But no pulse is palpated, one should consider the causes of pulseless electrical activity (electrical mechanical dissociation) these include hypothermia, hypoxia, hypovolemia, hyperkalemia, tension pneumothorax, pericardial tamponade, toxins and pulmonary thromboembolism, Acidosis, Hypoglycemia, TraumaIf there is bradycardia, asystole, venticualar tachycardia, or ventricular fibrillation, the patient requires drug therapy and when indicated defibrillation (400-Nelson 18th)Tracheal Intubation for ventilation - 4 major1. Suspected diaphragmatic hernia2. Tracheal suctioning for meconium aspiration3. Bag and mask is ineffective4. Prolong IPPV is requiredAdministration of epinephrine is not recommended unless the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressionHeimlich manoeuvre - used for management of airway obstruction due to foreign body* Manual thrust with the patients standing , rescuer behind the patiet and compressing the abdomen 6 to 10 timesAssisted ventilation (112-Suraj Gupta)Indication - Assisted ventilation should be initiated after stimulation if the infant remains apneic, is gasping or the heart rate remains <100 bpm**The assisted ventilation rate should be 40 to 60 inflations per minute - Lower rates allow longer inflation times and better coordinaton with chest compressions higher rate permit higher minute ventilation.