Lecture 2 - Neonatal Resuscitation Flashcards
Where does resuscitation start for neonatal resuscitation?
In Utero
When fetal heart rate decreases it indicates:
Asphyxia
Short term variability of the fetus means:
- 3-6 bpm
- CNS depressants reduce this short term variability
Long term variability of the fetus means:
Characterized by periodic accelerations correlating with fetal movements normally 15-40 accelerations per hour. Decreases seen with fetal sleep.
An absence of of short and long term variability may indicate:
fetal distress
Early deceleration patterns means:
-Vagal response to head compression, not associated with distress
Late deceleration paterns means:
- Uteroplacental insufficiency
- Decreased O2 supply, combined with lack of short term variability is ominous for fetal distress
Variable deceleration patterns means:
-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
What is a normal pH of a fetus?
7.25 - 7.35
A pH of < 7.20 for a fetus means:
Depressed neonate
How do you correct a FETUS in distress?
-Avoid and treat aortocaval compression
-correct hypotension
-Correct hypoxia
-Failure to remedy the situation calls for immediate
delivery
What are the main components of a neonatal assessment?
- Fetal heart Rate monitoring
- Apgar scores
- Fetal cord pH
- CPR
What categories does the apgar score upon?
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
Each category is scored differently in the apgar. What are the characterization of a ZERO.
- Flaccid (Activity)
- Absent (Pulse)
- No Response (Grimace)
- Pale/Blue (Appearance)
- Absent (Respiration)
Each category is scored differently in the apgar. What are the characterization of a ONE.
- Some flexion (Activity)
- < 100 (Pulse)
- Grimace (Grimace)
- Blue Extremities (Appearance)
- Weak (Respiration)
Each category is scored differently in the apgar. What are the characterization of a TWO.
- Well Flexed (Activity)
- > 100 (Pulse)
- Cough/sneeze (Grimace)
- Completely pink (Appearance)
- Good cry (Respiration)
Who is responsible for resuscitation of the neonate?
Neonatal care team
T/F: Anesthesia’s primary responsibility is the mother.
TRUE
If the HR is <60 or 60-80 and not rising what should be done for the neonate?
- Chest compressions
- ETT
T/F: It is not critical to keep a neonate warm.
FALSE
How do you know the correct ETT size for a neonate?
Leak at 20 cm H2O
When are the apgar scores usually done?
- 1 minute after birth
- 5 minute after birth
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 __.
7
5
20
7
How much fluid can be given to a neonate with low B/P?
10 cc/kg
What should be ruled out as causes of low B/P?
hypoglycemia
hypermagnesemia
hypocalcemia
What is the dose of EPINEPHRINE:
0.01-0.03 mg/kg (ETT administered with 1 cc)
What is the dose of Naloxone:
- 0.1 mg/kg IV or ETT
- 0.2 mg/kg IM
What is the dose for SODIUM BICARBINATE:
2 meq/kg IV over 2 minutes.
T/F: Increased doses are typically recommended for ETT route in pediatric resuscitation, but NOT recommended for neonatal resuscitation.
TRUE
