ACLS

Question 1

During the normal transition, the air that fills the baby’s lungs contains ____ % of oxygen.

Answer 1

21

Question 2

If a neonate does not begin breathing even after stimulation, you should presume that the baby is in ____ and will require ____ .

Answer 2

Secondary apnea; PPV

Question 3

What are the four pre-birth questions to be asked by the obstetric provider?

Answer 3

1. What is the expected gestational age?
2. Is the amniotic fluid clear?
3. Are there any additional risk factors?
4. What is our umbilical cord management plan?

Question 4

What does the ABC of resuscitation stand for?

Answer 4

Airways (position and clear – suction only if necessary)
Breathing (after stimulation – consider spontaneous or assisted)
Circulation (assess heart rate and color)

Question 5

First clean the ____ then the ____ when clearing the newborn’s airway.

Answer 5

Mouth; nose

Question 6

What are the first steps in neonatal resuscitation?

Answer 6

1. Warm and maintain normal temperature
2. Position
3. Clear airway
4. Dry and stimulate if needed

Question 7

In NRP, after initial rescuscitation, if the HR is below 100, or if the neonate demonstrates apnea or gasping, then the next step is ____ .

Answer 7

• PPV
• SpO2 monitor
• Consider EKG monitor

Question 8

In NRP, after initial rescuscitation, if the neonate demonstrates labored breathing or persistent cyanosis (but not apnea or gasping), the next steps are ____ .

Answer 8

• Position and clear the airway
• SpO2 monitior
• Supplemental O2 as needed
• Consider CPAP

Question 9

In NRP, after PPV has been initiated, if HR remains < 100 but > 60, the next steps are ____ .

Answer 9

• Check chest movement
• Ventilation corrective steps if needed
• ETT or laryngeal mask if needed

Question 10

In NRP. after PPV has been initiated, if HR is < 60, the next steps are ____ .

Answer 10

• Intubate if not already done
• Chest compressions
• Coordindate with PPV
• 100% O2
• EKG monitor
• Consider emergency UVC

Question 11

In NRP, after chest compressions have been initiated, if HR remains < 60, the next steps are ____ .

Answer 11

• IV epinephrine

Question 12

During neonatal resuscitation, how often can IV epinephrine be repeated?

Answer 12

Every 3-5 minutes

Question 13

What are the targeted preductal SpO2 sats after birth, by minute of life?

Answer 13

1 min - 60-65%
2 min - 65-70%
3 min - 70-75%
4 min - 75-80%
5 min - 80-85%
10 min - 85-95%

Question 14

For NRP, what is the concentration of epinephrine to use?

Answer 14

0.1 mg/mL

Question 15

For NRP, what is the suggested initial dose for IV/IO epinephrine?

Answer 15

0.02 mg/kg
(0.01 - 0.03 mg/kg)

Question 16

During NRP, when should you recheck a heart rate after administration of IV/IO epinephrine?

Answer 16

60 seconds after administration

Question 17

During NRP, what is the recommended ratio of compressions to ventilations, and at what speed?

Answer 17

3 compressions : 1 ventilation
This cycle takes place every 2 seconds.

Question 18

During NRP, how do you determine the insertion depth of the ET tube?

Answer 18

NTL [nasal-tragus length] + 1 cm

Question 19

If a baby’s condition suddenly worsens after intubation, what does the DOPE mnemonic stand for?

Answer 19

Dispalced endotracheal tube
Obstructed endotracheal tube
Pneumothorax
Equipment failure

Question 20

During NRP, where do you place your thumbs for chest compressions? How far do you compress?

Answer 20

On the center of the sternum just below the nipple line.
Compress 1/3 the AP diameter of the chest.

Question 21

During NRP, if administering a volume expander, what do you use? How much? Over what infusion duration?

Answer 21

Use NS, 10 mL/kg, over 5-10 minutes

Question 22

During NRP, when placing an emergency UVC, how far do you insert the catheter?

Answer 22

3-4 cm, until free flow of blood is obtained when you open the stopcock and gently aspirate

Question 23

In NRP, what are the steps of MR SOPA if ventilation is unsuccessful?

Answer 23

Mask adjustment
Reposition head/neck
– 5 breaths –
Suction mouth/nose
Open mouth
– 5 breaths –
Pressure increase
– 5 breaths –
Alternative airway

Question 24

How do you measure the insertion depth of an OG tube?

Answer 24

Measure from the bridge of the nose to the earlobe, and from the earlobe to a point halfway between the xiphoid process and the umbilicus.

Question 25

During NRP, as the heart rate increases over 100 and the baby begins to breathe, what are the next steps?

Answer 25

• Slow the rate of PPV
• Gently stimulate the baby
• Once the baby is breathing well enough to sustain a heart rate over 100, discontinue PPV

Question 26

In NRP, if the baby weighs more than ____ , a laryngeal mask bay be used as an alternative airway to avoid delays in care.

Answer 26

2 kg

Question 27

In NRP, what is the correct ET size (ID. or inner diameter) based on an infant’s weight?

Answer 27

< 1 kg - 2.5 mm
1-2 kg - 3.0 mm
> 2 kg - 3.5 mm

Question 28

In NRP, what is the correct ET size (ID, or inner diameter) based on an infant’s gestational age?

Answer 28

< 28w - 2.5 mm
28-34w - 3.0 mm
> 34w - 3.5 mm

Question 29

In NRP, what are the recommended PIP and PEEP?

Answer 29

PIP 20-25
PEEP 5

Question 30

In NRP, what is the correct rate of PPV?

Answer 30

1 breath every 2-3 seconds