Chapter 4 Resuscitation Techniques Flashcards
Causes of fetal asphyxia
-Maternal hypoxia
-Insufficient placental blood flow
-Blockage of umbilical blood flow
- Fetal disorders
Heart rate and blood pressure drops, PaCo2 rises and pH drops leading to asphyxia, weak, gasping and ineffective respirations.
Primary Apnea
There is no attempt to breathe again unless PPV is initiated.
Secondary Apnea
Initial adaptation of the of the fetal lungs to the extrauterine environment
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.
When blood flow continues to be shunted thru the F. Ovale and D. Arteriosus, bypassing the lungs as in fetal circulation.
PFC (Persistent Fetal Circulation)
-This leads to further asphyxia because little blood is coming in contact with the ventilated alveoli.
This gas may be used once the neonate is stabilized in order to achieve necessary pulmonary vasodilation.
iNO (Inhaled Nitric Oxide)
The first step in preparing for a neonatal resuscitation
Anticipation of a high-risk delivery
-Maternal history
-History of the pregnancy
-Continuous monitoring of the mother and fetus during L&D
If no information is available, the minimum information that may be useful is:
-The gestation age (term or preterm)
-Multiple neonates
-Presence of meconium
The second important part of the preparation
Properly functioning equipment
Necessary equipment
Suction Equipment
Bag and mask
Intubation
Medication
The third step in proper preparation
Trained Personnel who can direct resuscitation
What 3 questions should be asked upon delivery of the neonate?
- Is the neonate term?
- Is the neonate crying or breathing?
- Is there good muscle tone?
The first step in resuscitation of a neonate
Thermoregulation
-A cold baby will not respond to resuscitation efforts
The transfer of heat from one object to another without them coming in contact.
Radiant heat loss
(This is minimized by immediately placing neonate under a radiant warmer)
The loss of heat through direct contact of one object with a cooler surface.
Conductive heat loss
(This is minimized by placing the neonate on a warm blankets, towels, or heated mattresses)
The loss of heat through the evaporation of liquids from a surface.
Evaporative heat loss
(Thoroughly dry the baby with a warmed towel quickly)
The loss of heat due to the movement of air past the skin and carrying away heat
Convective
(This can be minimized by the prevention of cold drafts over the bed and keeping air movement to a minimum)
The second step in resuscitation of a neonate
Opening of the Airway
(Place neonate in sniffers position)
After proper positioning is achieved, suction the neonate
Suction the mouth first then the nose to prevent aspiration
-Suction should be gentle and limited to prevent vagal response.
A neonate with strong respiratory effort, good muscle tone and a HR greater than 100 bpm
This describes a vigorous neonate.
If there is meconium present and the neonate is not vigorous
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.
Evaluation of the heart rate
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.
Blueness of the hands and feet, pink trunk
Acrocyanosis
Oxygen saturation may be as low as ( ) at the time of delivery.
60%
-May take up to 10 minutes to reach 85% or above
The proper placement of a pulse ox
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.
Supplemental oxygen
-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
Oxygen blender
Allows the neonate to use a concentration of oxygen between 21% an 100% during the resuscitation.
What is an acceptable saturation on room air?
85% to 90% saturation on room air is acceptable, below 85% PPV may be in indicated.
When is PPV indicated?
PPV is indicated when the neonate is apneic, gasping, or when spontaneous breathing cannot maintain the heart rate above 100 bpm.
PIP
The amount of pressure delivered to the lungs at the end of inspiration via PPV.
A flow inflating bag can deliver up to how much oxygen?
100% O2
-Requires a gas source
-If a leak is present, the bag will not inflate or maintain pressure.
T-piece resuscitator
Requires a gas supply and is able to deliver precise and consistent pressures.
Chest compressions
A persistent HR of less than 60 will not meet the needs of the neonate so chest compressions should be initiated.
When using the 2 finger technique, the sternum is compressed at a rate of?
90 bpm
-Compressions end when the HR is above 60 bpm
-PPV continues until the HR rises above 100 bpm.
The proper ratio of compressions to ventilation
3:1
-Must be given within a 2 second time period.
-Ventilation should continue at 1 breath every 3 seconds.
When is intubation indicated during a resuscitation?
- When thick meconium is present
- 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 - In cases of extreme prematurity and surfactant is to be
administrated.
Intubation of a neonate and preemie
- 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.
Tube sizes
2.5 -Below 28 weeks
3.0-28 to 34 weeks
3.5-34 to 38 weeks
3.5 to 4-Above 38 weeks
How to evaluate proper tube placement?
-Auscultation of chest and stomach
-Equal bilateral chest movement
-End-tidal CO2 monitor
-Condensation in ET tube
-Radiograph
What are the only medications used during a resuscitation?
Epinephrine and volume expanders for blood loss
-Can be administered through the UVC.
This is a powerful drug that increases the strength of the contractions, causes peripheral vasoconstriction
Epinephrine
This may be used for hypovolemic shock due to acute blood loss
Volume Expanders
APGAR Scoring
5 areas are examined:
-RR
-HR
-Muscle tone
-Reflex irritability
-Color
Each score is given a 0, 1 or 2
How is nutrition supplied to the neonate?
The placenta
When does brown fat accumulate?
Brown fat accumulates during the last trimester
Normal Glucose levels
Normal glucose for a term baby is 35 or more.
Normal glucose for a preemie is 25 or more.
Low glucose levels in the blood
Hypoglycemia
High-risk factors for hypoglycemia
-Infants of diabetic mothers (IDMs)
-Rh incompatibility
-Prematurity
-Neonates who are small for their gestational age (SGA)
