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If the intratracheal dose is not effective, an intravenous dose should be administered as soon as possible [Class A, expert consensus opinion1,2,8] The recommended intravenous dose is 10�C30 microgram/kg (0.1�C0.3?mL/kg of a 1:10,000 solution) by a quick push [Class A, expert consensus opinion]. (1?mL contains 0.1?mg of adrenaline, so 0.1?mL = 10 microgram of adrenaline). It should be followed by a small saline flush. This dose can be repeated every few minutes if the heart rate remains http://www.selleckchem.com/products/Adriamycin.html higher doses may increase risk of post-resuscitation mortality and risk of intracranial haemorrhage and are not recommended [Class A, expert consensus opinion11�C13]. There is insufficient evidence for http://www.selleckchem.com/products/DAPT-GSI-IX.html the use of endotracheal adrenaline, but it is likely that a higher dose will be required to achieve similar blood levels and effect. If the tracheal route is used, doses of 50�C100 microgram /kg (0.5�C1?mL/kg of a 1:10,000 solution) should be used [Class B, extrapolated evidence14,15]. The efficacy and safety of these doses has not been studied.8 Intravascular fluids should be considered when there is suspected blood loss, the infant appears to be in shock (pale, poor perfusion, weak pulse) and has not responded adequately to other resuscitative measures [Class A, expert consensus opinion]. Isotonic crystalloid (normal saline) should be used in the first instance, but may need to be followed with blood suitable for emergency transfusion, in the setting http://www.selleck.cn/products/dabrafenib-gsk2118436.html of massive blood loss.8 Since blood loss may be occult, in the absence of history of blood loss, a trial of volume administration may be considered in babies who are not responding to resuscitation [Class B, expert consensus opinion8]. However, in the absence of history of blood loss, there is limited evidence of benefit from administration of volume during resuscitation unresponsive to chest compressions and adrenaline [LOE IV16], and some suggestion of harm from animal studies [LOE extrapolated evidence17,18]. The initial dose is 10?mL/kg given by IV push (over several minutes) [Class B, expert consensus opinion]. This dose may be repeated after observation of the response. Very rarely, a narcotic antagonist (naloxone) or sodium bicarbonate may be useful after resuscitation.8 ""Objectives:? To the best of knowledge, this was the first study of scapular manipulation technique (SMT) in Asia.