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IMPERIAL YEAR 5 SPECIALTIES - PAEDS > Apgar_score_flashcards > Flashcards

Apgar_score_flashcards

1
Q

What is the Apgar score used for?

A

The Apgar score is used to assess the health of a newborn baby.

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2
Q

When is the Apgar score assessed?

A

NICE recommend that it is assessed at 1, and 5 minutes of age. If the score is low then it is again repeated at 10 minutes.

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3
Q

What does a score of 2 for Pulse indicate?

A

> 100

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4
Q

What does a score of 1 for Pulse indicate?

A

< 100

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5
Q

What does a score of 0 for Pulse indicate?

A

Absent

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6
Q

What does a score of 2 for Respiratory effort indicate?

A

Strong, crying

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7
Q

What does a score of 1 for Respiratory effort indicate?

A

Weak, irregular

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8
Q

What does a score of 0 for Respiratory effort indicate?

A

Nil

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9
Q

What does a score of 2 for Colour indicate?

A

Pink

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10
Q

What does a score of 1 for Colour indicate?

A

Body pink, extremities blue

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11
Q

What does a score of 0 for Colour indicate?

A

Blue all over

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12
Q

What does a score of 2 for Muscle tone indicate?

A

Active movement

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13
Q

What does a score of 1 for Muscle tone indicate?

A

Limb flexion

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14
Q

What does a score of 0 for Muscle tone indicate?

A

Flaccid

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15
Q

What does a score of 2 for Reflex irritability indicate?

A

Cries on stimulation/sneezes, coughs

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16
Q

What does a score of 1 for Reflex irritability indicate?

A

Grimace

17
Q

What does a score of 0 for Reflex irritability indicate?

A

Nil

18
Q

What does a total Apgar score of 0-3 indicate?

A

A very low score

19
Q

What does a total Apgar score of 4-6 indicate?

A

A moderate low score

20
Q

What does a total Apgar score of 7-10 indicate?

A

The baby is in a good state

21
Q

Apgar score summary

A

Apgar score

The Apgar score is used to assess the health of a newborn baby. NICE recommend that it is assessed at 1, and 5 minutes of age. If the score is low then it is again repeated at 10 minutes.

Score Pulse Respiratory effort Colour Muscle tone Reflex irritability
2 > 100 Strong, crying Pink Active movement Cries on stimulation/sneezes, coughs
1 < 100 Weak, irregular Body pink, extremities blue Limb flexion Grimace
0 Absent Nil Blue all over Flaccid Nil

A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

22
Q

A baby is born via a category one caesarian section. The doctors are concerned that there is very little respiratory effort and begin to assess the child.

When should the APGAR score be assessed?

1 and 10 minutes of age
1 and 15 minutes of age
1 and 5 minutes of age
10 and 30 minutes of age
2 and 10 minutes of age

A

1 and 5 minutes of age

NICE recommend that APGAR scores are routinely assessed at 1 and 5 minutes of age
Important for meLess important
The APGAR score is used to assess the health of a newborn baby. APGAR scores should be assessed at 1 and 5 minutes of age.

The APGAR score includes an assessment of the pulse, respiratory effort, colour, muscle tone and reflex irritability.

A higher score indicates that the baby is in good health. A score of 0-3 is very low, 4-6 is moderately low and 7-10 suggests the baby is in a good state. If the score is <5 at 5 minutes, APGAR scores should be repeated at 10, 15 and 30 minutes and umbilical cord blood gas sampling should be considered.

5 minutes of age is correct.

None of the other answers is consistent with when APGAR scores should be assessed

23
Q

You are asked to attend an elective Caesarean section for macrosomia and maternal diabetes. At what times should you assess the APGAR scores?

1, 2 minutes
2, 5 minutes
0, 5 minutes
1, 5 minutes
2, 4 minutes

A

NICE recommend that APGAR scores are routinely assessed at 1 and 5 minutes of age
Important for meLess important
APGAR scores should improve as they are measured at 1 and 5 minutes.

If the score remains low, it should be remeasured.

APGAR is an mnemonic for the assessment of:
Appearance (colour)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort

24
Q

A baby is born at term via vaginal delivery with no complications, however he is still not showing signs of breathing at one minute. Heart rate is >100bpm, but he is floppy and cyanosed. What is the most appropriate next step in management?

Call for anaesthetist to intubate the baby
5 mouth-to-mouth rescue breaths
5 breaths of air via face mask
Start chest compressions
Suction airways

A

5 breaths of air via face mask

Airway suction should not be performed unless there is obviously thick meconium causing obstruction, as it can cause reflex bradycardia in babies. Chest compressions are not indicated, as the HR in this case is >100bpm. CPR should only be commenced at a HR < 60bpm. In cases where there are no signs of breathing and this is thought to be due to fluid in the lungs, five breaths should be given via a 250ml bag via face mask. This is a more effective and more hygienic method than using mouth-to-mouth in a hospital setting.

25
Q

You have just assisted with the normal vaginal delivery of a baby girl, during the delivery there was a large amount of meconium. On observation of the baby just after the birth the presence of which of following would prompt you to get the baby seen by the neonatal team?

Respiratory rate 75/minute
Baby crying
Heart rate of 145/min
Capillary refill of <3 seconds
Temperature of 36.5 ºC

A

Respiratory rate 75/minute

The correct answer here is a respiratory rate of 75/min. As per the NICE guidelines if any of the following are observed after any degree of meconium, then baby must be assessed by the neonatal team;
respiratory rate above 60 per minute
the presence of grunting
heart rate below 100 or above 160 beats/minute
capillary refill time above 3 seconds
temperature of 38°C or above, or 37.5°C on 2 occasions 30 minutes apart
oxygen saturation below 95%
presence of central cyanosis

26
Q

Which one of the following is not part of the Apgar score for assessing the newborn?

Colour
Respiratory effort
Tone
Heart rate
Capillary refill time

A

Capillary refill time

The correct answer is Capillary refill time. The Apgar score, developed by Dr. Virginia Apgar in 1952, is a quick and simple method used to assess the health of newborns immediately after birth. It comprises five components: colour, heart rate, reflexes, muscle tone, and respiration. Each component is scored from 0 to 2, giving a maximum total score of 10. Capillary refill time is not one of these components.

Colour measures the baby’s skin tone. A completely pink body scores 2 points; a blue or pale body scores 0 points; and if the body is pink but the extremities are blue or pale, it scores 1 point.

Respiratory effort evaluates the baby’s breathing and respiratory effort. If the baby isn’t breathing, it scores 0 points; if it’s slow or irregular breathing, it gets a score of 1; strong crying equates to a score of 2.

Tone, or muscle tone assessment takes into account whether limbs are flexed with active movement (scoring 2); some flexion with limited movement (scoring 1); or if there is no activity and muscles are flaccid (scoring 0).

The Heart rate component looks at whether there’s no heartbeat (scored as zero), fewer than 100 beats per minute (scored as one) or greater than or equal to 100 beats per minute (scored as two).

On the other hand, Capillary refill time, which refers to the time taken for colour to return to an external capillary bed after pressure has been applied to cause blanching, is not part of the Apgar scoring system. Although this can be an important indicator in assessing circulatory health in paediatric patients in general clinical practice settings outside delivery rooms, it does not feature in immediate post-birth assessments using the Apgar system.

27
Q

You have just helped deliver a 2 week premature baby and are asked to do a quick assessment of the current APGAR score. The baby has a slow irregular cry, is pink all over, a slight grimace, with a heart rate of 140 BPM and moving both arms and legs freely. The current APGAR score is?

5
6
7
8
9

A

8

This baby will score an APGAR of 8. The breakdown of points is as follows;

A - Pink all over no cyanosis - 2 points
P - Pulse rate over 100 - 2 points
G - Grimace - 1 point
A - Activity flexed arms and legs - 2 points
R - Respiration slow irregular cry - 1 point

A score of over 7 is generally accepted as normal

IMPERIAL YEAR 5 SPECIALTIES - PAEDS (422 decks)

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