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DR Resus WK2 Flashcards

1
Q

Resuscitation: Incidence

  • all births
  • PPV
  • ETT
  • chest compressions
A
  • 6-10% some degree
  • 5% PPV
  • 2% ETT
  • .1% chest compressions
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2
Q

Resuscitation: Risk Factors (Moderate Risk)

A
  • 34-27wk
  • 2-2.5kg
  • IUGR
  • fetal anemia/isoimmunization
  • polyhydramnios
  • GDM
  • prolapse cord
  • chorio/maternal fever
  • general anesthesia
  • stat c/s
  • intrapartum hemorrhage
  • abruption
  • MSAF
  • abnormal FHR tracing
  • instrumented delivery
  • breech
  • shoulder dystocia
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3
Q

Resuscitation: Risk Factors (High Risk)

A
  • <34wk
  • <2kg
  • fetal hydrops
  • major fetal anomalies that compromise respiratory transition
  • fetal bradycardia
  • acute or severe complication labor
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4
Q

NRP: Questions to Ask (4 + optional)

A
  • GA
  • Fluid - clear, meconium, blood
  • DCC
  • Risk factors
  • If time
    • FHR tracing
    • estimated weight (PT, NICU admin suspected)
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5
Q

SOBPIE: Meaning

A
  • Situation
  • Opinions
  • Basic manners
  • Parents
  • Info
  • Emotions
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6
Q

Shared Mental Model: Definition

A
  • perception, knowledge, understanding situation shared by team through communication
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7
Q

Types of Briefing

A
  • Pre brief - prior to delivery
  • Recap - during resuscitation
  • Debrief - reviewing resuscitation
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8
Q

Why to Debrief

A
  • improve pt outcomes
  • Identify training needs
  • Identify process failures
  • Improve morale
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9
Q

DCC Effects at 2yr

A
  • decrease death at 2yr
  • similar rate morbidity
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10
Q

Resuscitation: Prepartum Risk Factors

A
  • <36wk
  • >41wk
  • PE
  • Multiple gestation
  • Fetal anemia
  • Polyhydramnios
  • Oligohydramnios
  • Hydrops
  • LGA
  • IUGR
  • Malformations
  • No PNC
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11
Q

Resuscitation: Intrapartum Risk Factors

A
  • Stat c/s
  • Instrumented
  • breech/abnormal position
  • FHR category II or III
  • General anesthesia
  • Mag sulfate
  • Abruption
  • Intrapartum bleeding
  • Chorio
  • <4hr opioids
  • Shoulder dystocia
  • MSAF
  • Prolapsed cord
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12
Q

FHR: wnl

A

110-160bpm

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13
Q

FHR: Tachycardia

A
  • >160
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14
Q

FHR: Tachycardia Etiology

A
  • Infection
  • Hypoxia
  • Maternal drugs
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15
Q

FHR: Bradycardia

A

<110

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16
Q

FHR: Bradycardia Etiology

A
  • Hypoxia
  • Complete heart block
  • Maternal drugs (BB)
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17
Q

Accelerations: Indicate

A
  • Fetal movement
  • Indicator fetal well being
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18
Q

Decelerations: Types

A
  • Early
  • Late
  • Variable
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19
Q

Decelerations: Early Patho

A
  • Wnl
  • Head compression
  • Mirror image contraction
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20
Q

Decelerations: Late Etiology

A
  • Uteroplacental insufficiency
  • Fetal hypoxia
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21
Q

Decelerations: Late Definition

A

Nadir after contraction peaks

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22
Q

Decelerations: Variable Definition

A

V or W w rapid return to baseline

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23
Q

Decelerations: Variable Etiology

A
  • Abrupt compression cord
  • Oligohydramnios
  • Benign
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24
Q

Variability: Patho

A
  • Rapid fluctuations
  • Most sensitive indicator fetal well being
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25
Q

Variability: Wnl

A

6-25 moderate

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26
Q

Variability: Decreased Types

A
  • Minimal - <5
  • Absent - undetectable
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27
Q

Variability: Decreased Etiology

A
  • Severe hypoxia
  • Anencephaly
  • Maternal narcotics
  • Magnesium
  • Wnl fetal sleep cycle
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28
Q

FHR: Categories

A
  • I
  • II
  • III
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29
Q

FHR: Category I Definition

A
  • Baseline rate 110-160
  • Moderate variability 6-25
  • NO late or variable decels
  • Accelerations present
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30
Q

FHR: Category II Definition

A
  • NOT category I or III
  • Most common
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31
Q

FHR: Category III Definition

A
  • Sinusoidal pattern
  • Bradycardia
  • Absent variability
  • Decelerations
    • Recurrent late
    • Recurrent variable
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32
Q

Resuscitation: Maternal Hx Risk Factors and MGMT

A
  • Hemorrhage - volume expansion
  • Decrease FHR - prolonged resuscitation, hypothermic tx
  • Extreme PT - plastic wrap, thermal hat, decrease noise, light, positioning
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33
Q

NRP: Equpiment

A
  • Radiant warmer
  • Blanket towels
  • Bag and mask
    • Rate 5-8L
    • 20-25/5
    • max 30 PT, 40 FT/5
  • Stethoscope
  • Bulb suction
  • ETT w laryngoscope
  • O2
    • Rate 10L
    • FiO2 21-30%
  • Suction
    • 80-100mmHg
    • 10-12F catheter
  • Drugs and fluids
  • Syringes, needles, cannulas, IV lines, catheters
  • Meconium aspirator
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33
Q

NRP: Equipment

A
  • Radiant warmer
  • Blanket towels
  • Bag and mask
    • Rate 5-8L
    • 20-25/5
    • max 30 PT, 40 FT/5
  • Stethoscope
  • Bulb suction
  • ETT w laryngoscope
  • O2
    • Rate 10L
    • FiO2 21-30%
  • Suction
    • 80-100mmHg
    • 10-12F catheter
  • Drugs and fluids
  • Syringes, needles, cannulas, IV lines, catheters
  • Meconium aspirator
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34
Q

Fetal Asphyxia: Types

A
  • 1ary
  • 2ary

treat every DR apnea as 2ary bc CANT know

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35
Q

Fetal Asphyxia: 1ary Apnea s/s

A
  • Apneic
  • Cyanosis
  • Increase HR
  • Easy resuscitation (dry, suction, stim)
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36
Q

Fetal Asphyxia: 2ary Apnea s/s

A
  • Apneic
  • Pallor
  • Floppy
  • Decrease HR
  • Decrease BP
  • Active resuscitation
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37
Q

NRP Steps: 1st 30s

A
  • rapid assessment
  • warm, dry, stim
  • sniffing position
  • clear airway
  • additional tactile stim 5-10s
  • supp O2 by 30s
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38
Q

NRP: Rapid Assessment 1st 30s

A
  • FT
  • Good tone
  • Breathing or crying
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39
Q

NRP: Clear Airway Types and Methods

A
  • Bulb section preferred
    • Consider not using suction catheter until >5min life rt risk vagal (bradycardia)
  • suction canister
    • Mouth then nose
    • NOT >5cm deep
    • NOT >5s
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40
Q

NRP: Supp O2 Types

A
  • Blow by
  • CPAP
  • PPV
41
Q

NRP: Supp O2 Indications

A
  • Cyanosis
  • Respiratory distress
42
Q

NRP: Supp O2 if breathing Types

A
  • W cyanosis - blow by O2 5-8L/min
  • W respiratory distress - CPAP
43
Q

NRP: w apnea or gasping Types

A
  • PPV
  • ETT
  • LMA
44
Q

NRP: Target SpO2

  • 1min
  • 2min
  • 3min
  • 4min
  • 5min
  • 10min
A
  • 1min - 60-65%
  • 2min - 65-70%
  • 3min - 70-75%
  • 4min - 75-80%
  • 5min - 80-85%
  • 10min - 85-95%
45
Q

NRP: PPV Indications (3)

A
  • If remain apneic or gasping
  • HR <100
  • Persistent central cyanosis despite FiO2 100%
46
Q

NRP: PPV Contraindcations

47
Q

NRP: PPV Rate

48
Q

NRP: PPV Bag flow

49
Q

NRP: PPV Starting FiO2

A
  • >35wk 21%
  • <35wk 21-30%
50
Q

NRP: PPV Pressure

  • 1st breath
  • wnl lungs
  • decrease compliance
  • max
A
  • 1st breath - 30-40cmH2O
  • wnl lungs - 15-20cmH2O
  • decrease compliance - 20-40cmH2O
  • max
    • FT - 40cmH2O
    • PT - 30cmH2O
51
Q

NRP: PPV When should you notice chest rise?

A
  • 4-5th breath
  • NOT abdomen
52
Q

NRP: MR. SOPA

A
  • Mask adjust
  • Repositioning baby (sniffing)
  • PPV
  • Suction mouth and nose
  • Open mouth and lift jaw forward
  • PPV
  • Pressure increase every few breaths until chest wall movement
  • PPV
  • Artificial airway (ETT, LMA)
53
Q

NRP: What to do with NO chest movement or HR<60 despite adequate ventilation

A
  • alternate airway
54
Q

NRP: ETT Indciations

A
  • NO chest movement PPV
  • NO increase HR PPV
  • CDH congenital diaphragmatic hernia (NO PPV)
55
Q

NRP: ETT Landmarks

A
  • tongue
  • epiglottis
  • vocal cords → trachea/glottis
  • esophagus
56
Q

NRP: s/s misplaced ETT

A
  • Increase size stomach (esophagus)
  • Breath sounds louder over stomach (esophagus)
  • Decrease breath sounds L side (R mainstem)
  • NO improvement HR or color
57
Q

NRP: ETT Insertion Depth what GA or weight 5.5cm

A
  • GA 23-24wk
  • wt 500-600
58
Q

NRP: ETT Insertion Depth what GA or weight 6.0cm

A

GA 25-26wk

wt - 700-800

59
Q

NRP: ETT Insertion Depth what GA or weight 6.5cm

A

GA 27-29wk

wt 900-1,000

60
Q

NRP: ETT Insertion Depth what GA or weight 7.0cm

A

GA 30-32

wt 1,100-1,400

61
Q

NRP: ETT Insertion Depth what GA or weight 7.5cm

A

GA 33-34wk

wt 1,500-1,800

62
Q

NRP: ETT Insertion Depth what GA or weight 8.0cm

A

GA 35-37wk

wt 1,900-2,400

63
Q

NRP: ETT Insertion Depth what GA or weight 8.5cm

A

GA 38-40

wt 2,500-3,100

64
Q

NRP: ETT Insertion Depth what GA or weight 9.0cm

A

GA 41-43wk

wt 3,200-4,200

65
Q

NRP: Indications LMA

A
  • Airway malformation
  • Inability place ETT
66
Q

NRP: Chest Compressions Indications

A
  • HR<60 w adequate ventilation
67
Q

NRP: Chest Compressions How To

A
  • Thumbs lower ½ sternum (below nipples)
  • ⅓ AP diameter
  • 120/min
  • 3:1 compression:ventilation
  • 100% FiO2
  • Ideally, NOT leader (leader oversee)
68
Q

NRP: Epinephrine Indications

A

HR<60 w 60s chest compressions

69
Q

NRP: Epinephrine MOA

A
  • Peripheral vasoconstriction
  • Increase cardiac contractility
  • Increase HR
70
Q

NRP: Epinephrine Concentration

A

1mg/10ml (0.1mg/ml)

71
Q

NRP: Epinephrine Dose

A
  • TT 1ml/kg (0.1mg/kg)
    • Several ETT breaths
  • IV/IO 0.2ml/kg (0.2mg/kg)
    • Flush 3ml NS
    • Do NOT wait 3-5min for IV dose s/p ETT (give ASAP)
  • Q3-5min
72
Q

NRP: Epinephrine When to Assess s/p dose

A

60s s/p dose

73
Q

NRP: Volume Expander Indications

A

HR<60 AND evidence volume loss

74
Q

NRP: Volume Expander Dose

A

IV/IO 10ml/kg / 5-10min

75
Q

NRP: Volume Expander Types

A
  • NS
  • Lactated ringers
  • Uncrossmatched O- whole blood
76
Q

APGAR: What does it measure

A
  • HR
  • Respiratory Effort
  • Muscle Tone
  • Reflex (to pain)
  • Color
77
Q

APGAR: HR Points

A
  • 0 - absent
  • 1 - HR<100
  • 2 - HR>100
78
Q

APGAR: Respiratory Effort Points

A
  • 0 - Absent
  • 1 - slow, irregular
  • 2 - good, crying
79
Q

APGAR: Muscle Tone Points

A
  • 0 - limp
  • 1 - some flexion
  • 2 - active motion
80
Q

APGAR: Reflex to stim Points

A
  • 0 - No response to stim
  • 1 - grimace
  • 2 - cough, sneeze
81
Q

APGAR: Color Points

A
  • 0 - blue, pale
  • 1 - body pink, extremities blue
  • 2 - completely pink
82
Q

DR ER: PT Complications

A
  • hypothermia
  • respiratory distress
  • NDI
83
Q

DR ER: PT MGMT

A
  • Hypothermia
    • <27wk or <1kg - plastic wrap, thermal mattress
    • Room temp - 23-25C (74-77F)
  • Breathing
    • CPAP - non invasive vent improve outcomes
    • Lowest PIP necessary (protective ventilation)
    • Surfactant - esp extremely PT w intubation
      • Increase compliance
      • Decrease pressure for effective ventilation
  • NDI
    • Gentle handling and vent
    • Positioning
    • NO unnecessary stimulation
84
Q

DR ER: Pneumothorax s/s

A
  • Poor response w adequate ventilation
  • Sudden decompensation
  • Decrease unilateral breath sounds
  • Positive transillumination
85
Q

DR ER: Pierre Robin Sx MGMT

A
  • Prone
  • Pos insert ET into nare
86
Q

DR ER: Choanal Atresia s/s

A
  • blue breathing, pink crying
  • cant pass NG tube
87
Q

DR ER: Choanal Atresia MGMT

A
  • Airway through mouth always open
  • Modified pacifier into mouth for PPV
  • ET into mouth
88
Q

DR ER: CDH MGMT

A
  • NO air in stomach
  • NO PPV
  • Intubate asap
  • OG w continuous or intermittent suction
89
Q

DR ER: Myelomengocele MGMT

A
  • Latex free
  • Avoid position back
  • Avoid drying or rubbing defect
90
Q

DR ER: Gastroschisis, Omphalocele MGMT

A
  • Lower body in plastic bag
  • Position R side (optimize bowel perfusion)
91
Q

DR ER: Maternal Trauma Complications

A
  • Hypoveolmia
  • HIE
  • Birth trauma
92
Q

DR ER: Abruption/prolapsed cord Complicaitons

A
  • Hypovolemia
  • HIE
93
Q

DR ER: Shoulder Dystocia Complications

A
  • Birth trauma
  • HIE
94
Q

DR ER: Maternal Trauma MGMT

A
  • Volume expansion
  • UVC
  • Careful handling
95
Q

DR ER: Abruption/Prolapsed Cord MGMT

A
  • UVC
  • Volume expansion
  • Chest compressions
  • Epinephrine
96
Q

DR ER: Shoulder Dystocia MGMT

A
  • Careful handling
  • Intubation
  • Chest compressions
97
Q

Periviable: Definition

98
Q

Periviablity: Incidence for 23wk

A
  • 38% 23wk admitted to NICU survive
  • 35% 23wk survivors w/o sig NDI
99
Q

Congenital Anomalies: Incidence

A

3% births major structural or genetic birth defect

100
Q

NRP: when consider withdrawal care

A
  • poor response resuscitation and NO HR 20min

NNP I (9 decks)

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