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NRP 8th Edition 9/2024 > Chapter 4 PPV > Flashcards

Chapter 4 PPV Flashcards

1
Q

What are the Five Initial Steps after the baby is born?

A

Warm
Dry
Stimulate
Position Airway
Suction/clear airway
(p.56)

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2
Q

List four conditions that would require PPV?

A

HR <100
apnea or gasping
labored breathing
persistent cyanosis
(p.47)

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3
Q

What is the rate of PPV and pressure?

A

40-60 bpm
20-25 cmH2o
(p.67)

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4
Q

How is the effectiveness of PPV evaluated?

A

By a rising heart rate after the first 15 seconds
(p. 67)

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5
Q

What should you do if the HR is not rising after 15 seconds of PPV?

A

Initiate the “Ventilation Corrective Steps” aka “MR.SOPA”

  1. M- mask adjustment
  2. R - reposition the head and neck
  3. S - suction the mouth and nose
  4. O - open the airway
  5. P - pressure increase with PPV by 5-10 cm H2O
  6. A - Alternative Airway (LMA/ETT)

(p.

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6
Q

What happens if after 30 seconds of PPV that INFLATES the lungs and “Ventilation Corrective Steps” (MR.SOPA) and the heart rate is less than 60?

Two interventions

A

FiO2 to 100%
Begin compressions
(p. 67)

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7
Q

Can an ambu bag be used for free flow O2 of CPAP?

A

No
(p.71)

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8
Q

How soon after birth should a decision about the need for PPV be made?

A

60 seconds
HR should be > 100 with normal breathing
If not start PPV
(p. 75)

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9
Q

Where should you position yourself for PPV?

A

Head of the bed
(p. 76)

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10
Q

What is the most common reason for PPV ineffectiveness?

A

“improper positioning” (p.77)

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11
Q

How do you evaluate the response to PPV?

A

A rising heart rate. Should be rising by 15 sec and >100 by 30 seconds
(p. 81)

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12
Q

What should you do if the baby’s heart rate is not increasing after 15 seconds of PPV?

Three steps

A
  1. Assess if the chest is actually moving–is your PPV doing anything?
  2. If moving, 30 seconds more of PPV
  3. If not moving initiate “Ventilation Corrective Steps” (MR.SOPA)
    (p.82)
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13
Q

What are the three most likely reasons for ineffective PPV?

A
  1. air leak around mask
  2. airway obstruction
  3. insufficient ventilation pressure
    (p. 82)
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14
Q

After initiating MR.SOPA steps what should you do to verify if they worked?

A

Give 5 breaths and assess for chest movement
MR - grouped
SO -grouped
P
A

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15
Q

How should you increase the pressure during PPV if needed?

A

By 5-10 cmH2o at a time
(p.

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16
Q

What are the maximum PPV pressures for term and preterm babies?

A

MAX Term 40 cmH20
MAX preterm 30 cmH2o
(p. 83)

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17
Q

What should you do after 30 seconds of PPV that inflates the lungs?

A

Evaluate if HR is over 100bpm
If it is, titrate FiO2 down
Slow the rate of PPV
If HR stays over 100, then DC PPV
(p. 85)

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18
Q

What should you do if the HR is greater than 60 but less than 100?

A
  1. IF the HR is rising, continue PPV
  2. if the HR is not rising–assess for chest movement/ breath sounds
  3. If not rising– MR.SOPA
    (p.86)
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19
Q

What should you do if the heart rate remains below 60 bpm after 30 seconds adequate PPV? (preferably via LMA/ETT w. FiO2 of 100%?

A

Begin compression
(p.86)

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20
Q

What are some indications for CPAP?

3

A

Must be spontaneously breathing!
HR<100
labored breathing
(p.89)

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21
Q

What devices can deliver CPAP?

A

T-peice and free flow bag
(p.

22
Q

What is the MAX CPAP pressure?

A

8 cmH2O
(p.90)

23
Q

What are some criteria for the insertion of an OGT/NGT?

A

PPV or CPAP for more than several minutes”
(p. 91)

24
Q

What size OGT should be used?

A

8 Fr
(p. 91)

25
Q

What size OGT should be used with an LMA?

A

5-6 fR
(P. 91)

26
Q

How do you measure an NGT?

A

” from the bridge of the nose to the earlobe to a point halfway between the xiphoid process and the umbilicus”
(p.91)

27
Q

What are some pros of a self inflating/ambu bag?

A
  1. doe snot require compressed gas
  2. readily available
    (p. 94)
28
Q

What are three cons of a self inflating/Ambu bag?

A
  1. Because it self inflates, you will be less likely to know if there is seal leak.
  2. Can be difficult yo control inflation timing
  3. cant be used for free flow o2 or CPAP
    (P.94)
29
Q

Pros of a flow inflating bag?

A
  1. leaks revealed quickly because the bag will not inflate
  2. can deliver free-flow o2, CPAP/PEEP/PPV
    (p.95)
30
Q

What are some cons of a flow inflating bag?

A
  1. requires compressed gas
  2. harder to set up
    (p.94)
31
Q

What are some pros of a T-peice?

A
  1. provides a more constant pressure
  2. no need to squeeze a bag
  3. provides free flow, CPAP, PEEP
    (p.94)
32
Q

What are some cons of a T-piece?

A
  1. needs compressed gas
  2. more difficult setup
    (p. 94)
33
Q

Why not use 100% FiO2?

A

“mortality decreases in term and late preterm when 21% FiO2 is used versus 100% FiO2” “ decreases rebound pulmonary HTN”
(p. 95)

34
Q

What are some limitations of an LMA?

Five limitations

A
  1. may not ne able to suction secretions as well as ETT
  2. may leak under higher pressures
  3. chest compression may dislodge or cause airleak
  4. may not reliably deliver meds due to leaking
  5. may be too big for preemies
    (p. 96)
35
Q

What should you do if the HR is not rising within the first 15 seconds of PPV, and you DO NOT observe chest movement?

A

Start the ventilation corrective steps/ MR.SOPA
p. 67

36
Q

If the heart rate remains less that 60 bpm despite at least,
30 seconds of PPV that inflates the lungs,
MR.SOPA
adjusted FiO2 based on POX
What would your next step be?

A

Insert an alternative airway

p. 67

37
Q

You have provided PPV for a HR less than 60 and inserted an alternative airway, what are your next steps?

A
  1. Provide 30 seconds of PPV via alternative airway
  2. If the HR remains less than 60bpm increase FiO2 to 100%
  3. BEGIN COMPRESSIONS
    p. 67
38
Q

Using 21% FiO2 versus 100% FiO2 has been shown to promote what two physiologic parameters?

A
  1. appropriate decrease of vascular resistance
  2. prevents rebound pulmonary hypertension
  3. may preserve the inhaled nitric oxide if pulmonary hypertension develops.

p. 95

39
Q

The single most important and most effective step in neonatal resuscitation is?

A

Ventilation of the lungs

p. 97

40
Q

After the initial steps, PPV is indicated if the baby is_______ OR ______, OR if the baby’s HR is less than _____?

A

apneic, gasping, 100bpm

p. 98

41
Q

A baby is born limp and apneic. You place the baby under a radiant warmer, dry and stimulate, position the head and neck to pen the airway, and suction the mouth and nose. It has been 1 minute since birth and the baby remains apneic. The next step is to (stimulate more/PPV)?

A

ppv
p. 98

42
Q

At what rate do you administer PPV breaths?

A

40-60 min
p. 98

43
Q

For PPV at what rate should the flowmeter be set to?

A

10L/min
p.98

44
Q

What FiO2 should a term NB be ventilated with?

A

21%
p. 98

45
Q

At what inflation pressure should PPV be initiated with?

A

20-25 cm H20
p. 98

46
Q

What is the recommended initial PEEP setting?

A

5cm H20

p. 98

47
Q

You have started PPV for an apneic NB. The HR is 40 bpm and is not improving. Your assistant does not see chest movement. What you should you next move be?

A

Start the ventilation corrective steps (MR.SOPA)
p.98

48
Q

Inflation and aeration of the lungs is suggested by the colorimetric CO2 detector that turns what color?

A

yellow
p. 98

49
Q

You have started PPV for an apneic NB. The HR has remained 40 bpm despite performing all the ventilation corrective steps (MR.SOPA) and ventilating through an ETT for 30 seconds. Your assistant sees chest movement with PPV, You next step should be?

A

You should start chest compressions

p. 98

50
Q

What are the landmarks to measure an OGT?

A

bridge of nose to earlobe to between halfway between the xiphoid process and the umbilicus.
p. 98

51
Q
A

NRP 8th Edition 9/2024 (11 decks)

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