Lesson 3 NRP Flashcards
What’s the most important intervention in neonatal resuscitation?
Early PPV
List advantages of self inflating bags
-Bags remain inflated unless squeezed
-can deliver air, concentrated oxygen, or a blend
-most have pop off valve to prevent excess pressure being delivered to the lungs
List disadvantages of self inflating bag
-tight mask seal is required to ventilate
-Cannot deliver CPAP (continuous air)
-pressure release valves only release at very high pressures
List advantages of flow inflating bags
-Can deliver CPAP
-Pressure can be regulated with manometer
-can deliver positive end expiratory pressure (PEEP) and free flow oxygen
List disadvantages of flow inflating bags
-tight mask seal is required for bag inflation and ventilation
-requires oxygen source
-practical issues make them difficult to use
List T piece resuscitator advantages
-can deliver CPAP
-can deliver free flow oxygen
-peak inspiratory pressure can be regulated easily
-built-in manometer measures pressure (inspiratory ‘breathing in’ and expiratory ‘breathing out’)
List T piece resuscitator disadvantages
-Tight make deal is required
-Needs compressed gas
Easy to forget to release pressure for exhalation
What 5 steps does the provider need to take before delivering PPV?
1) clear airway
2) assume proper position
3) properly position baby’s head and neck
4) select appropriate mask
5) conceal tight seal with mask
What’s the proper position for the provider performing PPV?
Above baby’s head, (front of warmer). This position is best in order to place laryngeal mask or ETT if needed. May need to move to the side to administer chest compressions
If the airway has already been cleared should you suction it again before PPV starts?
Yes that’s good practice.
What does 1 handed mask seal technique allow you to do also?
Deliver ventilations with free hand
2 handed mask seal technique will require what
Another provider to provide ventilations
What’s the best way to secure the mask to the face?
Hold the mask and jaw together. Do not press down on baby’s head. Avoid compressing baby’s airway with downward force.
Steps 6-7 when preparing for PPV
6) select proper oxygen concentration
7) deliver ventilations at correct pressure and rate.
What’s the proper oxygen concentration for baby 35+ weeks genstation?
21%
What’s the proper oxygen concentration for baby >35 weeks genstation?
21%-30% (based on pulse oximetry)
What’s the starting peak ventilation pressure?
20-25 cm H²O
The first few breaths may require what pressure? (For baby who is full term)
30-40 cm H²O
If PEEP is used what ventilation pressure should you start with?
5cm H²O
What’s the rate of ventilations (bpm)?
40-60
It’s reasonable to deliver first breath for how long
Over 1 second or less
What indicates that there is a problem with PPV?
The chest is not rising
what’s the most important indicator of successful PPV ?
Heart rate increasing
How long should it take PPV to improve heart rate for baby with bradycardia?
15 seconds
After 15 seconds what should be announced?
If the heart rate is increasing or not
If chest is moving/not moving
If 15 seconds of PPV did not increase heart rate, but the chest is moving, what’s next?
Continue PPV another 15 seconds
After 15 seconds of PPV, the heart rate is not increasing, chest is not moving, what’s next?
Take corrective steps to get the chest to rise, check for leaks, airway obstructionsor if too little pressure is being delivered
What does MR. SOPA stand for?
Mask adjustment
Reposition airway
Suction mouth nose
Open mouth
Pressure increase
Alternative airway (ETT or laryngeal mask)
When should the second heart rate assessment be taken?
30sec of PPV that moves chest
At 30 sec heart rate assessment what do you check heart rate with?
Stethoscope, pulse oximeter or ECG
If heart rate is 60-99bpm after 30 sec of effective PPV, what’s next?
Check ventilation efforts and make improvements
If heart rate is less than 60 bpm after 30 sec of PPV, what’s next?
Place ETT or laryngeal mask and provide 30 sec PPV
After placing ETT or laryngeal mask and delivering 30 more seconds of PPV, heart rate is less than 60 bpm, what’s next?
Start chest compressions, supplemental oxygen, administer epinephrine
An ETT or laryngeal mask should be placed by
Properly trained providers, this class doesn’t teach how to do this
ETT is the airway of choice and requires a
Laryngoscope
What size laryngoscope blade and ETT for full term baby?
1 blade
What size laryngoscope blade and ETT for premature baby?
0 blade
What size laryngoscope blade and ETT for very premature baby?
00 blade
A 2.5mm ETT tube is used for
Baby’s less than 1 kg (2.2lbs) (usually >28 weeks gestation)
A 3.0mm ETT tube is used for
Babies weighing 1-2 kg (2.2-4.4 lbs) (usually 28-34 weeks gestation)
A 3.5mm ETT tube is used for
Babies more than 2kg (4.4 lbs) (usually >34 weeks gestation)
Where should ETT be placed?
1-2 cm below vocal cords (quick measure century of nose to tragus of ear (pointy flap)
It should take no longer than ___ secs to place ETT
30 sec
Should a provider try repeatedly attempt to intubate a neonate? Why?
No, each attempt is traumatizing and inflames airway
A correctly placed ETT should result in
Chest movement and bilateral breath sounds
What can be placed in the ETT to detect products of metabolism and has exchange?
CO² monitor
Positive CO² suggests (ETT placed)
Proper ETT placement
What provide s definite evidence of proper placement of ETT?
Chest X-ray
If neonate conditions worsens after ETT placement what are the 4 possible issues?
(DOPE)
Dislodged ETT
Obstructed ETT
Pneumothorax
Equipment problem
A laryngeal mask (LMA) is useful in cases when
Intubation is not possible
Laryngeal make can be helpful when baby has malformations of
Face, jaw, palate
What’s the most common laryngeal mask size available? What size baby will this not be useful for?
Size 1, 1,500 g (3.3 lbs usually 28-34 week gestation)
What advantage does the laryngeal mask have
It does not require a laryngoscope
When might a LMA leak air
Around cuff at high pressures
LMA cannot be used to
Clearing airway secretions
How to check proper placement on laryngeal mask?
CO² monitor
How many ventilations should it take in order to detect CO²
8-10 ventilations
What other signs should occur with proper placement of laryngeal mask?
Increased heart rate
Increasing SpO²
Bilateral chest movement
Breath sounds with ventilation
Because air administered through the LMA will enter the esophagus as well as the trachea, what should be inserted into the stomach? What for?
A gastric tube should be inserted into the stomach for decompression
Is LMA used for short-term or long-term
Short term
What increases the longer LMA is in use
Complications
When can LMA be removed
If baby needs transferred to a ETT instead or if baby breathes spontaneously
Since the LMA sits on top of vocal cords what can providers hear to let them know the baby has spontaneous breathing
Crying (an ETT is below the vocal cords so this doesn’t work for ETT)
