Lecture 2 - Neonatal Resuscitation

Question 1

Where does resuscitation start for neonatal resuscitation?

Answer 1

In Utero

Question 2

When fetal heart rate decreases it indicates:

Answer 2

Asphyxia

Question 3

Short term variability of the fetus means:

Answer 3

• 3-6 bpm

- CNS depressants reduce this short term variability

Question 4

Long term variability of the fetus means:

Answer 4

Characterized by periodic accelerations correlating with fetal movements normally 15-40 accelerations per hour. Decreases seen with fetal sleep.

Question 5

An absence of of short and long term variability may indicate:

Answer 5

fetal distress

Question 6

Early deceleration patterns means:

Answer 6

-Vagal response to head compression, not associated with distress

Question 7

Late deceleration paterns means:

Answer 7

• Uteroplacental insufficiency

- Decreased O2 supply, combined with lack of short term variability is ominous for fetal distress

Question 8

Variable deceleration patterns means:

Answer 8

-Related to cord compression
-Associated with fetal asphyxia when they are:
*> 70 bpm
*longer than 60 sec or
*occur in a pattern persisting for more than 30
minutes

Question 9

What is a normal pH of a fetus?

Answer 9

7.25 - 7.35

Question 10

A pH of < 7.20 for a fetus means:

Answer 10

Depressed neonate

Question 11

How do you correct a FETUS in distress?

Answer 11

-Avoid and treat aortocaval compression
-correct hypotension
-Correct hypoxia
-Failure to remedy the situation calls for immediate
delivery

Question 12

What are the main components of a neonatal assessment?

Answer 12

• Fetal heart Rate monitoring
• Apgar scores
• Fetal cord pH
• CPR

Question 13

What categories does the apgar score upon?

Answer 13

• Activity
• Pulse
• Grimace
• Appearance
• Respiration

Question 14

Each category is scored differently in the apgar. What are the characterization of a ZERO.

Answer 14

• Flaccid (Activity)
• Absent (Pulse)
• No Response (Grimace)
• Pale/Blue (Appearance)
• Absent (Respiration)

Question 15

Each category is scored differently in the apgar. What are the characterization of a ONE.

Answer 15

• Some flexion (Activity)
• < 100 (Pulse)
• Grimace (Grimace)
• Blue Extremities (Appearance)
• Weak (Respiration)

Question 16

Each category is scored differently in the apgar. What are the characterization of a TWO.

Answer 16

• Well Flexed (Activity)
• > 100 (Pulse)
• Cough/sneeze (Grimace)
• Completely pink (Appearance)
• Good cry (Respiration)

Question 17

Who is responsible for resuscitation of the neonate?

Answer 17

Neonatal care team

Question 18

T/F: Anesthesia’s primary responsibility is the mother.

Answer 18

TRUE

Question 19

If the HR is <60 or 60-80 and not rising what should be done for the neonate?

Answer 19

• Chest compressions

- ETT

Question 20

T/F: It is not critical to keep a neonate warm.

Answer 20

FALSE

Question 21

How do you know the correct ETT size for a neonate?

Answer 21

Leak at 20 cm H2O

Question 22

When are the apgar scores usually done?

Answer 22

• 1 minute after birth

- 5 minute after birth

Question 23

If the 5 minute score is less than __, repeat Apgar assessment every __ minutes until ___ minutes have passed or two successive scores are greater or equal to __.

Answer 23

7
5
20
7

Question 24

How much fluid can be given to a neonate with low B/P?

Answer 24

10 cc/kg

Question 25

What should be ruled out as causes of low B/P?

Answer 25

hypoglycemia
hypermagnesemia
hypocalcemia

Question 26

What is the dose of EPINEPHRINE:

Answer 26

0.01-0.03 mg/kg (ETT administered with 1 cc)

Question 27

What is the dose of Naloxone:

Answer 27

• 0.1 mg/kg IV or ETT

- 0.2 mg/kg IM

Question 28

What is the dose for SODIUM BICARBINATE:

Answer 28

2 meq/kg IV over 2 minutes.

Question 29

T/F: Increased doses are typically recommended for ETT route in pediatric resuscitation, but NOT recommended for neonatal resuscitation.

Answer 29

TRUE