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Perinatal & Pediatric Respiratory Care > Chapter 4 Resuscitation Techniques > Flashcards

Chapter 4 Resuscitation Techniques Flashcards

1
Q

Causes of fetal asphyxia

A

-Maternal hypoxia
-Insufficient placental blood flow
-Blockage of umbilical blood flow
- Fetal disorders

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2
Q

Heart rate and blood pressure drops, PaCo2 rises and pH drops leading to asphyxia, weak, gasping and ineffective respirations.

A

Primary Apnea

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3
Q

There is no attempt to breathe again unless PPV is initiated.

A

Secondary Apnea

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4
Q

Initial adaptation of the of the fetal lungs to the extrauterine environment

A

Step 1: The lung must rid itself of fluid and fill with air
Step 2: The decrease in PVR caused by an increase in o2 in he blood.
When asphyxia occurs, there is a disruption in one or both steps.

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5
Q

When blood flow continues to be shunted thru the F. Ovale and D. Arteriosus, bypassing the lungs as in fetal circulation.

A

PFC (Persistent Fetal Circulation)
-This leads to further asphyxia because little blood is coming in contact with the ventilated alveoli.

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6
Q

This gas may be used once the neonate is stabilized in order to achieve necessary pulmonary vasodilation.

A

iNO (Inhaled Nitric Oxide)

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7
Q

The first step in preparing for a neonatal resuscitation

A

Anticipation of a high-risk delivery
-Maternal history
-History of the pregnancy
-Continuous monitoring of the mother and fetus during L&D

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8
Q

If no information is available, the minimum information that may be useful is:

A

-The gestation age (term or preterm)
-Multiple neonates
-Presence of meconium

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9
Q

The second important part of the preparation

A

Properly functioning equipment

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10
Q

Necessary equipment

A

Suction Equipment
Bag and mask
Intubation
Medication

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11
Q

The third step in proper preparation

A

Trained Personnel who can direct resuscitation

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12
Q

What 3 questions should be asked upon delivery of the neonate?

A
  1. Is the neonate term?
  2. Is the neonate crying or breathing?
  3. Is there good muscle tone?
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13
Q

The first step in resuscitation of a neonate

A

Thermoregulation
-A cold baby will not respond to resuscitation efforts

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14
Q

The transfer of heat from one object to another without them coming in contact.

A

Radiant heat loss
(This is minimized by immediately placing neonate under a radiant warmer)

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15
Q

The loss of heat through direct contact of one object with a cooler surface.

A

Conductive heat loss
(This is minimized by placing the neonate on a warm blankets, towels, or heated mattresses)

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16
Q

The loss of heat through the evaporation of liquids from a surface.

A

Evaporative heat loss
(Thoroughly dry the baby with a warmed towel quickly)

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17
Q

The loss of heat due to the movement of air past the skin and carrying away heat

A

Convective
(This can be minimized by the prevention of cold drafts over the bed and keeping air movement to a minimum)

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18
Q

The second step in resuscitation of a neonate

A

Opening of the Airway
(Place neonate in sniffers position)

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19
Q

After proper positioning is achieved, suction the neonate

A

Suction the mouth first then the nose to prevent aspiration
-Suction should be gentle and limited to prevent vagal response.

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20
Q

A neonate with strong respiratory effort, good muscle tone and a HR greater than 100 bpm

A

This describes a vigorous neonate.

21
Q

If there is meconium present and the neonate is not vigorous

A

Suction the trachea
-This is done by intubating the neonate and attaching a meconium aspiration device along with the suction tubing to the end of the ET tube.
-Suction should be applied for up to 3 seconds, then continued as the tube is removed from the trachea.

22
Q

Evaluation of the heart rate

A

The heart rate should be greater than 100 bpm
-Measured at 6 seconds then multiplied by 10
-If above 100 bpm res. effort and color are evaluated
-If below 100 bpm PPV is initiated.

23
Q

Blueness of the hands and feet, pink trunk

A

Acrocyanosis

24
Q

Oxygen saturation may be as low as ( ) at the time of delivery.

A

60%
-May take up to 10 minutes to reach 85% or above

25
Q

The proper placement of a pulse ox

A

Right hand because it is preductal
-If placed in any other place it may include blood flow through the DA which has not participated in gas exchange, resulting in reduced gas exchange.

26
Q

Supplemental oxygen

A

-Be cautious: O2 toxicity can occur in minutes of high levels of O2
-Pre term neonates are more susceptible to O2 toxicity
-O2 blender is recommended because it allows

27
Q

Oxygen blender

A

Allows the neonate to use a concentration of oxygen between 21% an 100% during the resuscitation.

28
Q

What is an acceptable saturation on room air?

A

85% to 90% saturation on room air is acceptable, below 85% PPV may be in indicated.

29
Q

When is PPV indicated?

A

PPV is indicated when the neonate is apneic, gasping, or when spontaneous breathing cannot maintain the heart rate above 100 bpm.

30
Q

PIP

A

The amount of pressure delivered to the lungs at the end of inspiration via PPV.

31
Q

A flow inflating bag can deliver up to how much oxygen?

A

100% O2
-Requires a gas source
-If a leak is present, the bag will not inflate or maintain pressure.

32
Q

T-piece resuscitator

A

Requires a gas supply and is able to deliver precise and consistent pressures.

33
Q

Chest compressions

A

A persistent HR of less than 60 will not meet the needs of the neonate so chest compressions should be initiated.

34
Q

When using the 2 finger technique, the sternum is compressed at a rate of?

A

90 bpm
-Compressions end when the HR is above 60 bpm
-PPV continues until the HR rises above 100 bpm.

35
Q

The proper ratio of compressions to ventilation

A

3:1
-Must be given within a 2 second time period.
-Ventilation should continue at 1 breath every 3 seconds.

36
Q

When is intubation indicated during a resuscitation?

A
  1. When thick meconium is present
  2. If bag and mask ventilation is difficult or ineffective
    3.If prolonged PPV is required due to a disease.
    4.If chest compressions have become necessary
  3. In cases of extreme prematurity and surfactant is to be
    administrated.
37
Q

Intubation of a neonate and preemie

A
  • A term neonate =size 1 blade
    -Premature neonate= size 0 blade
    -Only Miller blades should be used until age 8 years old.
    -The black line on the ET tube should be at the level of the vocal cords.
38
Q

Tube sizes

A

2.5 -Below 28 weeks
3.0-28 to 34 weeks
3.5-34 to 38 weeks
3.5 to 4-Above 38 weeks

39
Q

How to evaluate proper tube placement?

A

-Auscultation of chest and stomach
-Equal bilateral chest movement
-End-tidal CO2 monitor
-Condensation in ET tube
-Radiograph

40
Q

What are the only medications used during a resuscitation?

A

Epinephrine and volume expanders for blood loss
-Can be administered through the UVC.

41
Q

This is a powerful drug that increases the strength of the contractions, causes peripheral vasoconstriction

A

Epinephrine

42
Q

This may be used for hypovolemic shock due to acute blood loss

A

Volume Expanders

43
Q

APGAR Scoring

A

5 areas are examined:
-RR
-HR
-Muscle tone
-Reflex irritability
-Color
Each score is given a 0, 1 or 2

44
Q

How is nutrition supplied to the neonate?

A

The placenta

45
Q

When does brown fat accumulate?

A

Brown fat accumulates during the last trimester

46
Q

Normal Glucose levels

A

Normal glucose for a term baby is 35 or more.
Normal glucose for a preemie is 25 or more.

47
Q

Low glucose levels in the blood

A

Hypoglycemia

48
Q

High-risk factors for hypoglycemia

A

-Infants of diabetic mothers (IDMs)
-Rh incompatibility
-Prematurity
-Neonates who are small for their gestational age (SGA)

49
Q
A

Perinatal & Pediatric Respiratory Care (5 decks)

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