DELIVERY ER

Question 1

• Depression or failure of the respiratory center
• Interference with the alveolar exchange of oxygen and carbon dioxide
• Do a chest x-ray

Answer 1

• CNS Failure
• Peripheral respiratory difficulty
• Respiratory distress

Question 2

• Cessation of breathing for greater than 15 to 20 seconds
• Responds to stimulation
• Need ventilatory assistance. A result of asphyxia or be ial disorders or prematurity

Answer 2

• Apnea
• Primary Apnea
• Secondary Apnea

Question 3

• Reestablish adequate spontaneous respiration and cardiac output
• High-risk situations should be anticipated from the history
• Infants who are born limp, cyanotic, apneic, or pulseless require immediate resuscitation before the 1-min APGAR score

Answer 3

Neonatal Resuscitation

Question 4

The 4 core steps in Early Intrapartum Newborn Care

Answer 4

1. Immediate and Through Drying
2. Early Skin-to-skin contact
3. Properly-Timed Cord Clamping
4. Non-separation of Newborn from Mother for Early Breastfeeding

Question 5

• Promotes early, continuous and prolonged skin-to-skin contact between the mother and the baby
• It is initiated in hospital and can be continued at home
• Small babies can be discharged early
• Mothers at home require adequate support and follow-up
• It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm infants

Answer 5

Kangaroo mother care (KMC)

Question 6

Kangaroo mother care (KMC): Maternal Criteria

Answer 6

• Freedom from any active, communicable disease
• Willingness to lactate & breastfeed
• Emotional stability
• Commitment to the KMC technique
• Ease & comfort in KMC 24 hours/day in the KMC room

Question 7

Kangaroo mother care (KMC): Neonatal Criteria

Answer 7

• Weight at enrolment <2,500gm
• Clinical stability for holding with or without feeding
• Prior to transfer to room/ward, ability to breastfeed in a coordinated fashion

Question 8

Kangaroo mother care (KMC) Important Points:

• position
• landmarks
• respirations
• PaO2
• Preterm oxygen

Answer 8

• Keep in a sniffing/neutral position e
• Landmarks: bridge of the nose to the tip of the chin
• Respirations: =40-60 breaths per minute at 15-20cm H2O (breath-2-3)
• Use room air in term infants
• Preterm infants use low oxygen 21 to 30%

Question 9

Effective PPV will improve:

Answer 9

• Color and oxygen saturation
• Muscle tone
• Spontaneous breathing

Question 10

Assisting ventilation

Apnea / gasping or HR <100 bpm?

Answer 10

• Ventilation corrective steps
• Intubate if needed

Question 11

Assisting ventilation

Labored breathing or persistent cyanosis

Answer 11

• Position and clear airway
  -SpO2 monitoring
• Supplemental O2 as needed
• Consider CPAP

Question 12

MR. SOPA means

Answer 12

• M =Mask reposition
• R =Reposition airway (sniffing position)
• S =Suction mouth and nose
• O =Open mouth
• P =Pressure increase
• A =Alternative airway (intubation)

Question 13

heart rate <60 bpm despite adequate ventilation for 39 seconds

Answer 13

• Intubate if not already done
• Coordinated PPY and chest compressions
• 100% O2
• Consider UVC insertion

Question 14

ET Tubing Tips
- landmark
- sternum
- technique
- compressions

Answer 14

• Landmarks: in between the nipple line on the lower 1/3 of the sternum
• Compress the sternum 1/3 of the AP diameter (1 and 2 and 3 and breath and)
• Preferred 2 thumb technique
• go compressions:30 breaths (3:1): 120 events per minute

Question 15

Drug if heart rate <60 bpm despite adequate ventilation and chest compressions

Answer 15

• IV epinephrine
  > Consider hypovolemia
  > Consider pneumothorax

Question 16

• Long bone fracture will present with pseudoparalysis
• Absent moro reflex on affected side
• Fractured humerus immobilize for 2-4wks
• Femoral fracture immobilize with spica cast
• Excellent prognosis

Answer 16

Extremity Fracture

Question 17

• Fractured during labor or difficult delivery
• Does not move the arm freely on the affected side and absent Moro reflex
• Crepitus and bony irregularity and
  discoloration
• Excellent prognosis
• Treatment is immobilization of the arm and
  shoulder

Answer 17

Clavicular Fractures

Question 18

• Due to trauma, anoxia, or severe stress (overwhelming infection)
• Present with profound shock and cyanosis
• Mass may be present in the lank along with overlying skin discoloration
• Diagnosis: Ultrasound
• Treatment of acute adrenal failure

Answer 18

Adrenal Hemorrhage

Question 19

• may result in the formation of a subcapsular hematoma
• Normal for the 1st 1-3 days
• Nonspecific signs related to loss of blood into the hematoma
• Mass palpable on the right upper quadrant and abdomen or inguinal area may appear blue
• Diagnosis: ultrasound
• Supportive therapy
• May require surgical repair

Answer 19

Hepatic Rupture

Question 20

• Good respiratory movements but unable to ventilate when mouth is closed
• Mouth should be open and clear of secretions
• Place an oropharyngeal airway

Answer 20

Bilateral Choanal Atresia

Question 21

• 1-2% of infants have at birth
• 0.05-0.07% have symptoms
• Higher risk:
  > Need PPV
  > Meconium stained amniotic fluid

Answer 21

Pneumothorax

Question 22

• 5-20 g/kg/min via continuous infusion
• Cardiogenic shock

Answer 22

Dopamine or dobutamine

Question 23

• 0.1-1.0 pg/kg/min via continuous infusion
• Severe shock

Answer 23

Epinephrine drip

Question 24

Infant has respiratory depression and mother received analgesic narcotic drug 4 hrs prior to delivery

Answer 24

Naloxone hydrochloride (0.1 mg/kg)

Question 25

Dose and Route for Epinephrine

Answer 25

• Concentration: 1:10,000 (0.1mg/ml)
• Route and dose:
  > IV at 0.1-0.3ml/kilo
  > ET at 0.3-1ml/kilo
  > dose repeated every 3-5mins