Lesson 6-7

Question 1

If it’s likely that the delivery will be complicated how many providers should be present at birth?

Answer 1

4+

Question 2

Resuscitation team should prepare roles ahead of time. You should know who will be performing…(List 7)

Answer 2

Initial assessment
Stimulation, position, drying
PPV
Chest compressions
Umbilical catheter insertion
Medication administration
time and note keeping

Question 3

What conditions can make resuscitation less effective or ineffective? (6)

Answer 3

Pneumothorax
Pleural effusion
Thick secretions
Robin sequence
Choanal atresia
Impaired respiratory drive

Question 4

If efforts to ventilate the neonate are not causing the chest to rise despite good technique the provider should

Answer 4

look for and adapt to conditions

Question 5

Define pneumothorax

Answer 5

Presence of air in plural space between chest wall and lung

Question 6

If a neonate has Pneumothorax a small amount of air is not usually a problem, but large amounts of air can interfere with ____

Answer 6

PPV

Question 7

(pneumothorax) the air can press on the heart and the contralateral (opposite) lung, this condition is called? _____

Answer 7

Tension Pneumothorax

Question 8

Risk factors for Pneumothorax: (4) PMLP

Answer 8

PPV
Meconium aspiration
Lung deformities
Prematurity

Question 9

If there is a sudden worsening in respiratory distress, providers should suspect ______

Answer 9

Pneumothorax

Question 10

What study diagnosis pneumothorax?

Answer 10

Chest xray

Question 11

Besides an X-ray how else can Pneumothorax be diagnosed?

Answer 11

Stethoscope and flashlight (decreased breath sounds, increased light penetration over affected area)

Question 12

Decreased breath sounds, during PPV may not indicate pneumothorax because they are other causes for this, such as: (5)

Answer 12

Poor ventilation technique
Not properly placed ETT
Tracheal obstruction
CDH
Other

Question 13

What can resolve small pneumothorax?

Answer 13

Supplemental oxygen therapy

Question 14

A large pneumothorax may require a provider to

Answer 14

Place catheter into pleural space to draw off air

Question 15

Where is the entry made to place catheter into plural space for pneumothorax?

Answer 15

Fourth intercostal space @ anterior axillary line or second intercostal space @ mid clavicular line

Question 16

What size needle to use for putting catheter into plural space for pneumothorax?

Answer 16

18-20 gauge needle) catheter system just on the top of next rib

Question 17

What way should the catheter be directed (pneumothorax)?

Answer 17

Directed upwards

Question 18

If a catheter kit is not available what can be used in an emergency? (Pneumothorax)

Answer 18

Butterfly needle

Question 19

When there is more definite treatment as far as pneumothorax goes and placing a catheter.. a ______ needs placed

Answer 19

Thoracostomy tube

Question 20

Pleural effusion is

Answer 20

The presence of fluid in the pleural space

Question 21

Presence of fluid in the pleural space can press on surrounding ______ and interfere with ______ & _______ efforts

Answer 21

Structures, breathing, ventilation

Question 22

What a clue to identifying pleural effusion?

Answer 22

Generalized edema

Question 23

Neonates with hydrops fetalis (severe abdominal swelling from edema, who are hard to ressusitate) are likely to have

Answer 23

Fluid in the pleural space

Question 24

What tool/exam can be used to diagnose large pleural effusions before birth? After delivery, how will breaths sound and what can be used to definitely diagnose baby?

Answer 24

Ultrasound, breath sounds will be diminished over effusion, xray

Question 25

Can small pleural effusions resolve on their own?

Answer 25

Yes

Question 26

Pleural effusions that's causing baby to struggle to breathe can be treated how?

Answer 26

Inserting catheter into pleural space and draining off fluid

Question 27

Where is entry made for catheter to drain a pleural effusion?

Answer 27

Entry is made at the 5th or 6th intercostal place along the posterior axillary line

Question 28

What size needle for pleural effusion catheter?

Answer 28

18-20 gauge needle/catheter on top of next rib

Question 29

What direction is the catheter positioned for pleural effusion?

Answer 29

Directed posterior

Question 30

Should you save fluid from pleural effusion to send to lab?

Answer 30

Yes

Question 31

What is Robin sequence also known as?

Answer 31

Pierre Robin syndrome

Question 32

What does Robin Syndrome cause?

Answer 32

Lower jaw doesn't develop properly in utero, a cleft palate

Question 33

In Robin sequence, the underdeveloped mandible and surrounding tissues block ____

Answer 33

Pharyngeal airway

Question 34

Robin sequence makes what type of masks difficult to insert during resuscitation?

Answer 34

ETT & LMA

Question 35

How to diagnose Robin sequence?

Answer 35

Visual inspection

Question 36

What way should a baby with Robin sequence be positioned for resuscitation? Why? If this doesn't open airway then what?

Answer 36

Prone position, so gravity pulls jaw and tounge away from pharyngeal airway. If it doesn't open airway, a small (2.5 mm) ETT can be placed in the nose

Question 37

Terminus (placement) of the ETT is not the in trachea but in the

Answer 37

Pharynx

Question 38

Why is ETT placed with Robin sequence?

Answer 38

To open upper airway

Question 39

(Robinson sequence) in severe cases of respiratory distress, make every effort to place a ________. This is usually easiest with baby in the prone position.

Answer 39

Laryngeal mask airway

Question 40

Babies normal only breathe through their mouth when they are _____

Answer 40

Crying

Question 41

Choanal atresia

Answer 41

Nasal airway is blocked by tissue in nasal cavity/upper pharynx

Question 42

Babies with choanal atresia can only breathe effectively when _____

Answer 42

They're crying

Question 43

Why can it be difficult to detect choanal atresia?

Answer 43

There are no external signs of disease

Question 44

What does a neonate with choanal atresia generally experience?

Answer 44

Cycles of oxygen destaturation, cyanosis (airway blocked) (Crying opens the airway)

Question 45

What can test for choanal atresia ?

Answer 45

A suction catheter gently applied through the nares into the posterior pharynx

Question 46

Thin suction catheter cannot pass into the pharynx and or is not visible when looking into the mouth, you can make the presumptive diagnosis of ______

Answer 46

Choanal atresia

Question 47

Definite diagnosis and treatment of ______ ; requires a specialist

Answer 47

Choanal atresia

Question 48

What can you do to stabilize a baby with choanal atresia?

Answer 48

Insert an oral airway, ETT that terminates in the pharynx, or a feeding nipple that has been cut open and placed into neonates mouth to allow air flow. Both of these devices should be secured to the baby's head to retain proper placement.

Question 49

A diaphragmatic hernia is usually diagnosed via sonogram @ how many weeks gestation?

Answer 49

18-22

Question 50

Symptoms of CDH at birth are:

Answer 50

Diminished lung sounds Respiratory distress Tachycardia Bowel sounds in chest

Question 51

What type of ventilation should be avoided with babies who are born with CDH? And what should be done immediately?

Answer 51

Bag mask ventilation, they should be intubated

Question 52

(CDH) In order to prevent intestinal distension and compression of the available lung tissue,what must be inserted?

Answer 52

And orogastric tube (used to deliver meds or food or remove contents)

Question 53

Separate _______ and _______ should be placed while awaiting urgent pediatric surgery consultation and treatment.

Answer 53

Umbilical artery, vein catheters

Question 54

Neonates with CDH are at high risk for ______ and will likely require ____, _____ &______

Answer 54

persistent pulmonary hypertension, inhaled nitric oxide, vasopressor support (meds that help raise blood pressure), & extracorporeal membrane oxygenation (machine that temporarily performs functions of heart and lungs)

Question 55

Women who have taken opioids within 4 hours prior to delivery require ______

Answer 55

Special attention

Question 56

Opioids depress the drive to breathe, so neonates with opioids on board may have _____

Answer 56

Impaired respiratory drive

Question 57

How to treat baby with opioids on board?

Answer 57

Support with ventilation until baby metabolizes and clears the opioid. Once this happens baby should breathe spontaneously.

Question 58

Studies have shown that when mothers are on opioids or methadone treatment that ______ & _____ should not be used. What could happen if opioid receptor antigens are used in baby? (3)

Answer 58

Naloxone & other opioid receptor antigens. Could cause baby to have withdrawal seizures, pulmonary edema, & cardiac arrest

Question 59

Congenital heart malformations such as transposition of the great vessels and Tetralogy of Fallot (4 heart problems, usually are grey/blue skin due to low oxygen) can cause ____, these symptoms don't usually appear in immediate postnatal period. But ____________

Answer 59

Cardiopulmonary impairment, But severe cardiac abnormalities can appear immediately.

Question 60

When should congenital heart malformations be suspected?

Answer 60

When neonate is cyanotic(blue purple skin) and tachypneic (rapid breaths)