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Sinclair Paramedic 2150 > 8- Neonatology > Flashcards

8- Neonatology Flashcards

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1
Q

Newly born

A

Infant at time of birth

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2
Q

Newborn

A

Infant within first few hours of birth

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3
Q

Neonate

A

Infant within the first month of being born

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4
Q

Antepartum risk factors for resuscitation (8)

A
  • Multiple gestation
  • No prenatal care
  • Mom is <16 or >35 y/o
  • Polyhydramnios or Oligohydramnios
  • History of stillbirth
  • Post term gestation
  • Drug use during pregnancy
  • Eclampsia, HTN, Diabetes, Toxemia
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5
Q

Intrapartum risk factors for resuscitation (7)

A
  • Premature labor
  • Meconium
  • Membrane rupture >24hrs before delivery
  • Abnormal presentation
  • Prolonged delivery
  • Prolapsed cord
  • Bleeding
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6
Q

Steps of neonatal resuscitation (5)

A

1-Dry, warm, stimulate, suction for 30 seconds
2- HR >100 HR w/ central cyanosis, free flow O2 30 seconds
2.5- Poor respirations <100 HR, BVM 40-60/min for 30 seconds
3- HR >60 begin compressions 3:1 and ET
4- No improvement after 30 sec start ALS
5- No signs of life after 10 min, consider termination

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7
Q

Fetal transition

A

Series of events needed to enable newborn to breath as its delivered

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8
Q

The 3 shunts from adult to newborn

A

1-Ductus venous
2-Ductus arteriosus
3- Foramen ovale

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9
Q

Weeks of gestation for pre, term and post term delivery

A

Preterm- Less than 37 weeks
Term- 38 to 42 weeks
Postterm- More than 42 weeks

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10
Q

What causes a newborn to begin its own breathing

A

Hypoxia and hypercapnia related to partial occlusion of the umbilical cord during normal delivery

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11
Q

NEEDED equipment for newborn delivery (14)

A
  • Bulb syringe
  • 5F to 14F suction catheter
  • 8F feeding tube with 20 mL syringe
  • Pedi BVM
  • Laryngoscopes 00, 0, 1
  • ET tubes 2 to 4
  • EPI (0.1 mg/mL)
  • 250 mL D10
  • Umbilical catheters 3.5F and 5F
  • 1 through 50 syringes
  • 26 through 18 g needles
  • OPA’s 0, 00, 000
  • Plastic wrap
  • Warming pad
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12
Q

What is suctioned first in a newborn

A

MOUTH

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13
Q

What needs to be examined as newborn is delivered

A
  • ABC’s
  • APGAR
  • Skin discoloration
  • Head symmetry
  • Eyes
  • Umbilical cord
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14
Q

Target O2 sat at 1-10 min for a newborn

A 
1- 60 to 65%
2- 65 to 70%
3- 70 to 75%
4- 75 to 80%
5- 80 to 85%
10- 85 to 95%
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15
Q

How long can you suction a newborn for

A

No more than 10 seconds

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16
Q

When and how much free flow O2 is applied to a newborn

A

Cyanotic, pale

5 Lpm

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17
Q

Why would a newborn need an OPA

A

Bilateral Chantal atresia
Pierre Robin sequence
Macroglossia
Other craniofacial defects

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18
Q

In what case can nasal intubation not be done

A

Choanal atresia

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19
Q

What is choanal atresia

A

Bony or membranous obstruction of the back of the nose preventing air flow

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20
Q

Pierre Robin Sequence

A

Developmental abnormalities including small chin, posteriorly positioned tongue leading to airway obstruction

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21
Q

How to relieve Pierre Robin sequence

A

OPA, depress tongue dont rotate OPA

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22
Q

Signs of resp distress for BVM use in newborn

A

Periodic breathing
Intercostal retractions
Nasal flaring
Grunting on expiration

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23
Q

When to use BVM on newborn

A

Inadequate respiratory effort
HR less than 100 after initial stimulation
Other signs of resp distress

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24
Q

Common causes of respiratory distress in a newborn (11)

A
  • Lung, heart disease
  • CNS disorder
  • Pneuothorax
  • Meconium aspiration
  • Premature development
  • Shock/Sepsis
  • Diaphragmatic hernia
  • PERSISTENT PULMONARY HYPERTENSION
  • Airway obstruction
  • Pneumonia
  • Metabolic acidosis
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25
Q

Most common reasons for ineffective BVM in a newborn

A
  • Poor seal
  • Incorrect head position
  • Copious secretions
  • Pneumothorax
  • Equipment malfunction
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26
Q

What cases would a newborn need to be intubated

A
  • Meconium stained fluid
  • Diaphragmatic hernia
  • Prolonged PPV is needed
  • Craniofacial defects
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27
Q

Gastric decompression indication in a newborn (4)

A

-Prolonged ventilations
-Abdominal distention impeding ventilation
-Diaphragmatic hernia
-Gastrointestinal congenital anomaly
(Pyloric stenosis)

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28
Q

Signs of Diaphragmatic hernia

A
  • Decreased breath sounds of left side
  • Concave abdomen
  • Increased work of breathing
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29
Q

Steps of inserting OG tube in newborn (4)

A

1- 8F feeding tube measured from bottom of earlobe to nose to in between xiphoid process and umbilicus

2- Insert through mouth, leave nose open

3- Attach 10 mL syringe, bubble, suction stomach

4- Tape to cheek, intermittently suction

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30
Q

When is CPR indicated in a newborn

A

HR less than 60 despite positioning, clearing airway, drying/stimulation and 30 seconds of effective PPV

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31
Q

2 techniques of CPR for a newborn

A
  1. Thumb

2. Two finger

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32
Q

How many compressions and breaths per minute in newborn CPR

A

90 compressions

30 breaths

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33
Q

Steps to establish umbilical IV (6)

A
  1. Clean, drape towels all around
  2. Put 3mL syringe and 3.5-5F on stopcock
  3. Cut cord between tie about 1” from skin
  4. Insert line into umbilical vein at 12 position
  5. Advance catheter .75 to 1.5” until blood can be aspirated
  6. Flush with .5 mL NS, tape in place
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34
Q

What is Gastroschisis

A

Portion of the abdominal organs herniate through weak area of abdominal wall, no membrane covering on them

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35
Q

What is Omphalocele

A

Portion of abdominal organs protrude through umbilicus, thin membrane covering organs

-Non intact omphalocele = Organ membrane is ruptured or torn

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36
Q

Typical birth weight at

  • 28 weeks
  • Term
A

28 weeks- 2.5 lbs avg

Term- 6.5 to 9 lbs avg

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37
Q

What is apnea

  • Result
  • Causes (6)
A

Respiratory pause of greater than 20 seconds

  • Can lead to BradyC, hypoxemia
  • Mom/baby narcotic exposure, resp muscle weakness, septicemia, abnormal labor, gastroesophageal reflux, CNS abnormality
38
Q

Primary vs secondary apnea

A

Primary- Short period of hypoxia, period of rapid breathing followed by apnea and BradyC, resolved by stimulation

Secondary- Hypoxia continues during primary apnea, newborn will gas, not resolved by stimulation, PPV is required

39
Q

What frequently causes BradyC in a newborn

A

Hypoxia

40
Q

What may be the cause for BradyC after adequate ventilation, compressions and volume expansion

A

Acidosis

41
Q

Acidosis treatment in a newborn

A

Find and reverse the cause

42
Q

Pneumothorax (newborn)

  • Causes
  • S/S
  • Treatment
A

Causes- Inhales meconium, weak lung from infection

S/S-Resp distress w/o any improvement, decreased breath sound, shifted heart sounds

Treatment-Needle decompression

43
Q

Newborn needle decompression

  • Indication
  • Procedure
A

Pneumo, decreased breath sound, shifted heart sound

  • 22 g butterfly to extension tubing to stopcock to 20 mL syringe
  • Above 2nd rib, remove air and repeat air removal as needed
44
Q

Can you give Narcan to an infant with chronic or acute narcotic exposure

A

Acute

45
Q

Best place for IV establishment in newborns

A
  • Dorasl hand

- Greater saphenous (foot/ankle)

46
Q

Seizures (Newborns)

A

Strongly suggest presence fo neurological disorder

  • Paroxysmal alteration in neurological function
  • More common in premature
  • ECG confirms diagnosis
47
Q

Seizures (Newborn)
S/S (5)
Treatment

A

S/S-Deviation or fixation of eyes, can be triggered by stimulus, clinic jerking, lethargy, apnea

Treatment-BGL, vitals, CMC benzos, monitor

48
Q

Hypoglycemia (Newborns)
Causes
S/S
Treatment

A

BGL less than 45, usually a symptomatic until BGL below 20

Causes- Metabolic, stress

S/S-Cyanosis, apnea, hypotonia (limp), ALOC, Irregualr resps

Treatment- BGL, Vitals, IV, D10

49
Q

Esophageal atresia

A

Failure to develop the distal lumen

50
Q

Infantile Hypertrophic Pyloric Stenosis

A

Hypertrophy and hyperplasia of the two muscular layers of the pylorus, becomes thickened, obstructs the end of the stomach

51
Q

Malrotation

A

Congenital anomaly of rotation fo the midgut

-Small bowel found on R side

52
Q

Intestinal atresia (Intestinal stenosis)

A

Congenital, parts of bowel may not have developed or may be narrow

53
Q

Hirschsprung disease

A

Last segment of colon fails to relax and causes mechanical obstruction

54
Q

Causes of neonatal seizures (6)

A
  • Hypoxic ischemic encephalopathy
  • Intracranial infection
  • Hypoglycemia
  • Epileptic syndrome
  • Hypocalcemia
  • Drug withdraw
55
Q

Vomiting (Newborn)
S/S
Treatment

A

S/S- Distended abd, fever/hypothermic (sepsis), apnea/BradyC, Abd tender/guarding, minimal bowel sounds

Treatment- ABC’s, Naso or OG tube?, Fluid (10mg/kg per bolus)

56
Q

Most common cause of diarrhea in newborns

A

Viral infection

57
Q

Diarrhea (Newborn)

A

Excessive loss of electrolytes and fluid in stool

S/S- Ill looking, poor vitals, Cap refill >2 sec, dry mucous membranes, poor skin turgor, sunken eyes

Treatment- ABC’s, O2, Fluid (10 mL/kg blouses)

58
Q

Causes of neonatal jaundice

Treatment

A

Hemolysis, RBC disorders, polycythemia

Treatment- IV fluid, communicate to ER

59
Q

Fever (Newborn)

Rectal ,Oral and Axillary

A

Rectal- > 100.4
Oral- > 99.4
Axillary- > 98.4

60
Q

Can newborns sweat or shiver

A

NO

61
Q

Newborn fever treatment

A

Remove excess clothing layers, improve ventilation in the environment

62
Q

Newborn hypothermia

A

Body temp less than 95

63
Q

Newborn hypothermia risk factors (6)

A
  • 8 to 12 hrs after birth
  • Prolonged resuscitation
  • Small for gestational age
  • CNS problems
  • Premature birth
  • Sepsis
64
Q

Increase in metabolic function in newborns to produce heat can result in (4)

A
  • Hypoglycemia
  • Metabolic acidosis
  • Pulmonary hypertension
  • Hypoxemia
65
Q

Hypothermia (Newborns)
S/S
Treatment

A

S/S- Cool to touch, pale/acrocyanosis, apnea, BradyC, cyanosis, lethargic, weak cry, sclerema

Treatment- Cap on head, reward, D10W, warm fluid

66
Q

Sclerema

A

Hardening of the skin associated with reddening and edema

67
Q

Birth trauma

A

Included preventable and non-preventable injuries from mechanical forces during delivery

68
Q

Caput Succedaneum

A

Swelling of the soft tissue of the newborns scalp as it presses against the dilating cevrix

69
Q

Cephalohematoma

A

Area of bleeding between parietal bone and its covering periosteum, raised lump

70
Q

Most common brachial plexus injury at birth

A

Erb palsy (C5, C6)

71
Q

Klumpke paralysis (C8 to T1)

A

Rare, results in the weakness of intrinsic muscles of the hand

72
Q

Pseudoparalysis

A

Avoiding movement of injured body part to prevent pain

73
Q

Most frequently injured bone in a newborn

A

Clavicle

74
Q

Consider intra-abdominal bleeding in every newborn presenting with

A

Shock
Unexplained pallor
W/ abdominal distention

75
Q

Congenital Heart Disease (CHD)

-Presentation

A

Abnormalities of the heart during development. The most common birth defect

Presentation- Increasing resp distress, poor perfusion, cyanosis, eventual cardiovascular collapse

76
Q

Best place for a pulse ox reading

A

Right hand

77
Q

Noncyanotic disease

A

Includes Atrial septal, ventricular septal, ductus arteriosus , ductus venous defects and coarctation of the aorta

78
Q

Effects of Artiral septal defects

A

Enlargement of both atria
Pulmonary hypertension
OR
Asymptomatic

79
Q

Effects of ventricular septal defects

A

Reduced stroke volume
RVH
RAE
Pulmonary hypertension

80
Q

What is patent ductus arterious

A

The Ductus arterious fails to close after birth allowing blood flow to bypass the right ventricle and lungs due to the fetus’s lungs being filled with fluid

81
Q

Patent ductus arterious

S/S

A 
Fatigue
Failure to thrive
Poor feeding
Bounding peripheral pulses
Characteristic murmur
Increased work of breathing
82
Q

Coarctation of the aorta (CoA)

S/S

A

Narrowing of the aorta, LV has to work harder, increased pressure to head and arms and decreased pressure to body and legs.
Can result in heart failure or poor perfusion

S/S
Dyspnea, poor weight gain
High BP/bounding pulses in arms but not lower body
Chest pain, weakness
Differential cyanosis
Dizzy, nosebleeds
83
Q

Cyanotic disease

-Examples

A

Congenital abnormalities which deoxygenated blood (R side) mixes with oxygenated blood (L side)
Called a right-to-left shunt.

Examples- Truncus arteriosus, Tricuspid atresia, Hypoplastic left heart syndrome, tetralogy of Fallot

84
Q

Pulmonary stenosis

S/S

A

Disease damages pulmonic valve of the right side of the heart, decreasing blood flow to the lungs

S/S- JVD, Cyanosis, RVH

85
Q

Truncus Arteriosus

S/S

A

Pulmonary artery and Aorta are combined into one, causes heart failure early in life

S/S- Lower O2 sat resulting in cyanosis

86
Q

Tricuspid Atresia

A

Lack of tricuspid valve, resulting in undersized or absent right ventricle and significantly decreased blood flow into the lungs

87
Q

Hypoplastic Left Heart Syndrome

A

Complete underdevelopment of the left side of the heart, extremely small aorta, mitral and aortic valves may be closed

Can not fulfill circulation needs of the body

88
Q

Tetralogy of Fallot

A
  • Combination of ventricular septal defect, pulmonary stenosis, RVH and overriding aorta
  • Aorta is connected between left and right ventricles over ventricular septal defect
89
Q

Tetralogy of Fallot, tetralogy (tet) spell
S/S
Treatment

A

Arterial O2 suddenly decreases, from increased constriction of lung outflow, further restricting pulmonary blood flow

S/S- Cyanosis, Irritability, Hyperpnea
-Can result in seizures, syncope, death

Treatment- Knee to chest position, O2, IV/Fluid, CMC meds

90
Q

Transposition of the Great Arteries

S/S

A

Positions of Aorta and Pulmonary artery are reversed

Can only survive if heart defects are present

S/S- Heart failure, hypoglycemia, SOB, clubbing

91
Q

Total Anomalous Pulmonary Venous return

A

Rare, the 4 pulmonary veins do not connect to left atrium but to right atrium

Sinclair Paramedic 2150 (16 decks)

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