Asphyxia and Resuscitation Flashcards
What are the degenerative enzymes in asphyxia
Proteases (calpase)
Nitrogen oxide synthase
Phospholipiase
Criteria for HIE
Criteria include clinical and biochemical components
▪ History of perinatal asphyxia event
▪ Evidence of acute acidosis on umbilical artery gas pH <7.00 or BE > −12)
▪ Apgar < 5 at 10 minutes or continued need for mechanical ventilation at 10 minutes after birth
▪Neurologic criteria
▪ Seizure
▪ Or evidence of moderate to severe encephalopathy on examination (must have at least three to six components in the moderate to severe category)
Which ventilation device can provide consistent tidal vol, PIP, PEEP
T-piece
Earliest sign of adequate ventilation
Rising HR
How to trouble shoot ventilation?
MR SOPA
Mask
Reposition
Suction
Open airway
Pressure- inc to produce adeq chest rise
Alternative
Goal of event in compression to breath
- 120 events/min
- 3:1 ratio
- 90 compression: 30 breaths
Contraindication for delayed cord clamping
- maternal hemorrhage
- need for immediate neonatal resuscitation
- disrupted placental circulation such as placental abruption, previa, or cord avulsion
What is the focus of neonatal resuscitation
Effective ventilation of the baby’s lungs
-Unlike adults, primary problem is lack of gas exchange
What are the events for successful fetal to neonatal circulation
- First deep breath and cry: fluid reabsorbed, lung fills with air
- O2 relax pulmonary vessels: increase pulmonary blood flow
- Oxygenated blood returns to the heart to ensure perfusion to heart and brain
- Clamping of the cord increases systemic blood flow, dec tendency for blood to bypass the baby’s lungs
What are the clinical findings of abnormal transition
- irregular breathing, apnea, tachypnea
- bradycardia/ tachycardia
- decreased tone
- Pale skin or cyanosis
- Low oxygen
- Low BP
What are the 4 pre birth questions
- Gestational age
- Amniotic fluid clear
- Additional risk factor
- Umbilical cord management
What are the rapid evaluation questions in newborn
- term?
- tone?
- breathing or crying?
- If no, bring to warmer
True or false
If meconium stained amniotic fluid present, routine laryngoscopy should be done
False
-If unable to inflate lungs and airway obstruction suspected- intubation and tracheal suction may be necessary
What is target oxygen saturation
Indications to start PPV
- Apnea
- Gasping
- HR<100
Why not routinely use 100% during all neonatal resuscitation
Mortality decreased among term and late preterm with 21%
Primary method of confirming endotracheal intubation
- Exhaled CO2
- Inc HR
Baby worsens after intubation, what to consider
- D-isplacement
- O-bstruction
- P- neumothorax
- E- quiment
Endotracheal tube size
ET insertion depth
How deeply do you compress the chest
1/3 of the AP diameter
Do not squeeze the chest
Thumb should remain in contact
Epinephrine:
Concentration-
Dose-
Flush-
Concentration: 0.1mg/ml, 1mg/10ml, 1:10000
Dose: 0.02mg/kg (0.2ml/kg) range 0.01-0.03
Flush 3 ml
Goal: improve coronary A perfusion & O2 delivery via inc strength & rate
Volume expansion recommendation
10ml/kg
rate 5-10 mins
- Should not be routinely given in absence of shock or history of acute blood loss; large volume load may actually worsen cardiac output and further compromise the newborn
Temperature in the room where resuscitation takes place
23-25C (74-77F)
To avoid neurologic injury while resuscitation in preterm neonate
- handle baby gently
- avoid positioning legs higher than head
- avoid high PPV/CPAP pressures (>40/>6)
- use pulse ox
- avoid rapid IV infusion
Why premies have higher risk for hypothermia
- Thin skin
- Dec SQ fat
- Large surface area to body mass
- limited response to cold
What is the first preferred vasopressor for septic shock
Norepinephrine
- acts on both α1- and β1-adrenergic receptors: vasoconstriction (α1 effect) and an increase in CO (directly through β1 effect and indirectly through increased MAP)
- does not routinely increase pulmonary vascular resistance
Which vasopressor is contraindicated in aortic stenosis
Dobutamine
Sources of heat loss
- Evaporative- water
- Radiant-cooler object
- Convective- cooler air
- Conductive- cooler surface
Prevent heat loss at delivery via
1. DR temo 73.4-77F
2. plastic wrap
3. thermal mattress
4. hat
Low Apgar score in neonates is associated with—
Increased risk for CP
