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My Decks > ISCN > Flashcards

ISCN Flashcards

1
Q

Depth of high lying UAC insertion?

A

Weight in kg * 3 + 10 cm

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2
Q

Depth of UVC insertion?

A

(Weight in kg * 3 + 10cm)/2

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3
Q

Size of ET tube for <1 kg (<28 weeks)?

A

2.5

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4
Q

Depth of insertion of ET tube for <1 kg (<28 weeks)?

A

6-7cm

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5
Q

Size of ET tube for 1-2 kg (28-34 weeks)?

A

3.0

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6
Q

Depth of insertion of ET tube for 1-2 kg (28-34 weeks)?

A

7-8cm

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7
Q

Size of ET tube for 2-3 kg (34-38 weeks)?

A

3.5

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8
Q

Depth of insertion of ET tube for 2-3 kg (34-38 weeks)?

A

8-9cm

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10
Q

Size of ET tube for >3 kg (>38 weeks)?

A

3.5-4.0

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11
Q

How to score APGAR: Appearance

A

2 pink*
1 acrocyanosis
0 pale or blue
*use oral mucosa for dark-skinned babies

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12
Q

How to score APGAR: Pulse

A

2 HR >100
1 HR < 100
0 No HR

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13
Q

How to score APGAR: grimace

A

2 Tap foot or suction nose- cry
1 Grimace
0 No response

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14
Q

How to score APGAR: activity

A

2 Strong flexion
1 Weak flexion
0 Flaccid

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15
Q

How to score APGAR: respiration

A

2 Strong cry or regular resp with good effort
1 Weak effort or irregular resp
0 No Effort

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16
Q

Depth of insertion of ET tube for >3 kg (>38 weeks)?

A

9-10cm

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17
Q

MR SOPA

A 
Mask adjustment
Reposition airway
Suction mouth then nose
Open mouth
Pressure increase (turn dial on CPAP)
Airway alternative (LMA, intubation)
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18
Q

Normal SpO2 at 1 min of life?

A

60-65%

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19
Q

Normal SpO2 at 2 min of life?

A

65-70%

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20
Q

Normal SpO2 at 3 min of life?

A

70-75%

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21
Q

Normal SpO2 at 4 min of life?

A

75-80%

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22
Q

Normal SpO2 at 5 min of life?

A

80-85%

23
Q

Normal SpO2 at 10 min of life?

A

85-95%

24
Q

First 3 questions to ask when you arrive at a birth?

A

Term
Tone
“Tachypnea” (breathing/crying)

25
Q

If term, good tone, vigorous cry - what do you do?

A

Warm
Dry
Airway clearance
Give to Mom

26
Q

If not term, good tone, vigorous cry - what do you do?

A 
Warm
Dry
Stimulate 
Airway clearance 
Check HR
27
Q

HR <100, gasping, or apnea - what do you do?

A

PPV

SpO2 monitor

28
Q

HR still <100 after 30 sec PPV. What do you do?

A

MR SOPA

Continue PPV

29
Q

HR < 60. What do you do?

A

Chest compressions with PPV (1 and 2 and 3 and breathe)
Consider intubation
Think about IV access/UVC for epi

Assess airway first - if you intubated and HR improves to >60 no compressions

30
Q

HR still < 60 despite compressions with PPV. What med can you give?

A

IV epi (1:10,000 at 0.1-0.3ml/kg)

31
Q

What else should you be doing/checking while doing chest compressions and PPV? What 2 etiologies should you consider?

A

MR SOPA

Consider hypovolemia, pneumothorax

32
Q

If HR > 100 but there is labored breathing or persistent cyanosis what should you do?

A

Airway clearance
SpO2 monitor
Consider CPAP

33
Q

If HR > 100, breathing okay after warm, dry, stimulate - what do you do?

A

Routine care/give to Mom

34
Q

For how long after birth does the hypoglycemia protocol apply?

A

24 hours

35
Q

Name 3 maternal conditions that put baby at risk for hypoglycemia.

A

Diabetes
Chorioamnionitis
Hyperthyroidism

36
Q

Name 3 maternal meds (classes) that put baby at risk for hypoglycemia.

A

Beta blockers
TCAs
Some diabetes meds (insulin, glyburide)

37
Q

Name 5 things that put baby at risk for hypoglycemia via limited glycogen supply.

A
  • APGAR score <5 at 5 minutes
  • Cord blood gas pH <7.2
  • Intubation at birth for any reason
  • Category 3 fetal heart tracing resulting in alpha or beta c/s
  • Forceps or vacuum assisted delivery
38
Q

Name 2 things that put baby at risk for hypoglycemia via hyperinsulinism.

A

Beckwith-Weidmann syndrome

Immune hemolytic disease (erythroblastosis)

39
Q

Name 3 things that put baby at risk for hypoglycemia via diminished glucose production.

A

BW < 2500 g
BW > 4500 g
Oligohydramnios

40
Q

Name 2 misc things that put baby at risk for hypoglycemia.

A

Significant congenital anomalies (gastroschisis, CDH)

Temp <36 C

41
Q

Name 10 signs of hypoglycemia in a newborn. (Hint: Neuro x 4, vital signs x 4, cry, ID)

A 
AMS (Lethargy, irritability, stupor)
Poor suck/poor feeding
Seizures/convulsions
Tremors/jitteriness
Temperature instability
HR < 80
Irregular respirations, apnea, tachypnea
Central cyanosis
Weak or high-pitched cry
Sepsis/infection
42
Q

What do you do if baby has symptoms of hypoglycemia?

A

Check POC glucose STAT

43
Q

What is the dose of oral dextrose gel?

A

0.2 g/kg

44
Q

What is the dose and duration of IV dextrose bolus? What about infusion to follow?

A

D10W at 2ml/kg over 10min

5-8mg/kg/min (80-100 ml/kg/day)

45
Q

When baby is on D10W infusion, what glucose level do you titrate to?

A

> =50

46
Q

What if you can’t get an IV for D10W within 15 min or 4 attempts?

A

Place UVC

47
Q

An asymptomatic baby with hypoglycemia risk factors has glucose >40. What do you do?

A

Feed q2-3h

Check POC glucose before each feed (or at least q2-3h, if cluster feeding)

48
Q

Glucose > 45. What do you do?

A

Feed q2-3 hours

Obtain POC at 3,6,12,24hrs of life

49
Q

Glucose 25-45. What do you do?

A

Oral dextrose gel 0.2 g/kg
BF or formula at least 15ml
Obtain POC in 30min

50
Q

Glucose <25. What do you do?

A

Oral dextrose gel 0.2 g/kg
BF or formula at least 15ml
Transfer to ISCN for 2ml/kg D10 bolus
Obtain POC in 30 min

51
Q

Glucose 25-45 on 3rd check. What do you do?

A 
(Treat like <25)
Oral dextrose gel 0.2 g/kg
BF or formula at least 15ml 
Transfer to ISCN for 2ml/kg D10 bolus
Obtain POC in 30 min
52
Q

Oral dextrose syringes come in what concentration?

A

0.8g/2ml

53
Q

What do you do if baby is asymptomatic but has hypoglycemia risk factors?

A

Feed the baby!
(Breast or bottle within 1 hr of birth, or try cup, NG)
Recheck POC glucose 30 min after feed completion or at 1 hour

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