164. Neonatal resus

Question 1

3 major physio changes that must occur at birth

Answer 1

o Removal of fluid to allow ventilation
o Lung expansion and creation of functional reserve
o Redistribution of cardiac output to perfuse lungs

Question 2

7 reasons to start resus

Answer 2

Hypoxia
Hypothermia
Hypoglycemia
Hypovolemia
Prematurity
Meconium stain
Maternal

Question 3

Indications of hypoxia

Answer 3

• May take time to get good pulse ox
• Initial hypoxia leads to rapid gasps, then apnea, the lowered HR
• Bradycardia (<100) is major indicator of hypoxia
• Eventual hypotension

Question 4

RFs for hypoglycemia

Answer 4

• Poor stores
• Small babies
• Diabetic moms
• May be response to other causes
• Associated with worse neuro outcomes
• Any under 2.2 should get IV glucose

Question 5

Causes of hypovolemia

Answer 5

• Rare and usually due to blood loss
• Maternal hemorrhage
• Cord accident
• Trauma

Question 6

Prematurity RFs for resus

Answer 6

• Particularly <34 weeks
• Pulm hypo maturity and susceptible to hypothermia
• CPR requirement bad predictor of outcomes
• Should intubate if in resp distress

Question 7

Maternal RFs for resus

Answer 7

Infection
-	Chorioamniaotis
-	IV abx
Meds
-	Opiods in particular can resp depress
-	Consider antenatal drug abuse

Question 8

4 indications to withhold resus

Answer 8

• <23 weeks
• BW <400g
• Anencephaly
• If unclear, start resus
• If no sign of life after 10 minutes can resus

Question 9

signs of diaphragmatic hernia

Answer 9

o Barrels chest
o Loss of breath sounds
o Tracheal displacement

Question 10

mgmt for diaphragmatic hernia

Answer 10

• BMV will distend stomach and worsen hypoxia

- Intubate immediately

Question 11

MGMT of Omphalocoel or myelomeningocele

Answer 11

• Place prone to not place pressure
• High risk of latex allergy
• Wrap defect in warm gauze and wrap in plastic
• Resus PRN
• OG tube
• Usually need IVF

Question 12

mgmt of choanal atresia

Answer 12

• Upper airway obstruction can cause severe resp distress
• Can’t pass catheter in the nares
• Oral airway to bypass obstruction

Question 13

5 findings for critical cardiac disease

Answer 13

o	BP gradient between upper and lower
o	Weak femoral pulses
o	Central cyanosis
o	Patho murmur
o	Hepatomegaly

Question 14

when to give PGE1

Answer 14

ductal dependent lesions

Question 15

6 ductal dependent lesions, 3 pulmonary and 3 systemic

Answer 15

Pulm
- pulmonary stenosis, atreisa
- severe tricuspid atresia
- tetralogy of fallot
Systemic
- hypoplastic L heart
- critical aortic stenosis
- interupted aortic arch

Question 16

First 5 steps right after birth

Answer 16

Dry
Warm
position
suction
stimulate

Question 17

First check in NRP alorithm (3)

Answer 17

Term
Tone
Breathing

Question 18

2 indications to start PPV

Answer 18

Apnea or gasping

HR <100

Question 19

5 parts of APGAR

Answer 19

HR
Resp
Tone
Reflex irriibility
Color

Question 20

Indication for 100% O2

Answer 20

HR<60

Question 21

Steps to take if further deterioration

Answer 21

MR SOPA
Mask adjust
Reposition
Suction
Open mouth
Pressure increase
Airway alternative

Question 22

Indication to start compression

Answer 22

HR <60 despite good ventilation and O2

Question 23

4 possible adjunct meds

Answer 23

Epi
Dopamine
Glucose
Volume expansion

Question 24

4 most common bacteria for sepsis

Answer 24

 GBS
 E coli
 Klebsiella
 Listeria

Question 25

Preferred vascular access

Answer 25

Umbilical vein

then IO