The VEB approach to NRP-unresponsive shock: In addition to standard NRP procedures, the following may be attempted with appropriate judgment.
| VALIDATE (RECONFIRM) INFORMATION | ESCALATE (INTERVENTIONS AND CALLS FOR HELP) | BROADEN (DIAGNOSTIC AND THERAPEUTIC CONSIDERATIONS) | |
|---|---|---|---|
| Airway and breathing | Ensure that end-tidal carbon dioxide, bilateral breath sounds, and chest rise are definitely present; most neonatal instability is caused by inadequate ventilation1 | Escalate to endotracheal tube insertion if appropriate, especially if doubt exists regarding the proper functioning of supraglottic airway device1 | If deterioration occurs postintubation, consider DOPE mnemonic (displacement, obstruction, pneumothorax, equipment failure) |
| Circulation | Ensure ECG is monitored1 and blood pressure is measured (if relevant) | Consider treating hypovolemia by administering a crystalloid bolus (10 mL/kg)1 | Consider broader possible etiologies of shock (Box 11,2) |