Kettering Emergency Care

Question 1

What are the initial steps following delivery?

Answer 1

Warm, maintain airway, suction mouth then nose, stimulate, 30 sec evaluation of HR, RR, and color.

Question 2

If meconium is present and the newborn is not vigorous, what should you do? (x4)

Answer 2

1. Insert laryngoscope and suction w/12-14 fr catheter
2. Insert ET Tube
3. Attach ET tube to mec aspirator, suction and withdraw tube
4. Repeat with new ET tube if necessary

Question 3

Four critical life functions (In order)

Answer 3

Ventilation
Oxygenation (Most common)
Circulation
Perfusion

Question 4

What is the normal urine output for infants?

Answer 4

2 ml/kg/hour

Question 5

What is the normal RBC value?

Answer 5

4.1-5.7

Question 6

RBC x 3 = ___.

Answer 6

Hb

Question 7

Hb x 3 = ___.

Answer 7

Hct

Question 8

Normal blood glucose for an infant is ___.

Hypoglycemia is under ___.

Answer 8

55-115

40

Question 9

Normal L/S ratio is ___.

Under ___ is BAD!

Answer 9

3: 1 or 4:1
1: 1

Question 10

What is L/S?

Answer 10

Lecithin / Sphingomyelin

Question 11

What is PG?

Answer 11

Phosphatidylglycerol

Question 12

What is PC?

Answer 12

Phosphatidylcholine

Question 13

Use this drug to decrease blood pressure in eclamsia.

Answer 13

Magnesium Sulfate

Question 14

High bilirubin levels present with ___. They may indicate liver failure or ___.

Answer 14

Jaundice, Rh incompatibility.

Question 15

Name two ways to induce labor.

Answer 15

Give oxytocin

Stripping or sweeping of amniotic membranes

Question 16

What are late decelerations?

Answer 16

Bradycardia starts with contraction and doesn’t stop.

Give mom O2. Baby in trouble!

Question 17

What are variable decelations?

Answer 17

Bradycardia independent of contractions. Umbilical cord is compressed. Reposition mother.

Question 18

If pre-ductal PaO2 is more than ___ greater than post-ductal PaO2, ___ may be present.

Answer 18

15 torr

Right to left shunt

Question 19

What should you do if PaCO2 is elevated? (Must be in order)

Answer 19

1. Decrease or remove any mechanical deadspace.
2. Increase the corrected tidal volume or pressure if appropriate.
3. Increase resp. rate.

Question 20

What should you do if PaCO2 is low? (Must be in order)

Answer 20

1. Decrease tidal volume or pressure if appropriate.

2. Decrease respiratory rate.

Question 21

What should you do if the PaO2 and SaO2 are low?

Answer 21

1. Increase FiO2 in 5-10% increments (Not higher than 60%
2. Increase PEEP in increments of 2-3 until something happens, either good or bad.
3. If pt has increased ICP or bad cardiac function, raise FiO2 above 60% instead of raising PEEP.

Question 22

What should you do if PaO2 and SaO2 are too high?

Answer 22

1. Decrease FiO2 to below 60%

2. Decrease PEEP.

Question 23

How do you calculate appropriate flow?

Answer 23

Flow = (Tv x rate) x (I+E)

These are all desired settings

Question 24

How do you calculate airway resistance?

Answer 24

Peak pressure - Plateau pressure

Set pressure support to this number or greater

Question 25

When should you consider lung protective strategies?

Answer 25

FiO2 60% and high PEEP
High PIP (30 or greater)
Low PaO2 and decreased compliance (ARDS)

Question 26

Six lung protective strategies are:

Answer 26

Permissive Hypercapnea
Optimal PEEP
Pressure Control Ventilation
Pplat less than 30
ARDSnet
Shorter I-time

Question 27

How do you calculate Dynamic Compliance?

Answer 27

Corrected Tv / PIP - PEEP

Question 28

How do you calculate Static Compliance?

Answer 28

Corrected Tv / Pplat - PEEP

Question 29

What is normal static lung compliance?

Answer 29

60-100 mL/cm H2O

Question 30

What size laryngoscope blade do you use on a term neonate?
What size blade for a pre-term neonate?
What size blade for a micro-premie, <1000 grams?

Answer 30

Term: size 1
Pre-term: size 0
Micro-premie: size 00

Question 31

How do you figure out how deep to insert the tube?

Answer 31

Add baby’s weight (in kg) to 6.

ex: for a 1000 gram baby, 1000 = 1kg. 1 + 6 = 7. Insert the tube 7cm.