Lesson 6-7 Flashcards
If it’s likely that the delivery will be complicated how many providers should be present at birth?
4+
Resuscitation team should prepare roles ahead of time. You should know who will be performing…(List 7)
Initial assessment
Stimulation, position, drying
PPV
Chest compressions
Umbilical catheter insertion
Medication administration
time and note keeping
What conditions can make resuscitation less effective or ineffective? (6)
Pneumothorax
Pleural effusion
Thick secretions
Robin sequence
Choanal atresia
Impaired respiratory drive
If efforts to ventilate the neonate are not causing the chest to rise despite good technique the provider should
look for and adapt to conditions
Define pneumothorax
Presence of air in plural space between chest wall and lung
If a neonate has Pneumothorax a small amount of air is not usually a problem, but large amounts of air can interfere with ____
PPV
(pneumothorax) the air can press on the heart and the contralateral (opposite) lung, this condition is called? _____
Tension Pneumothorax
Risk factors for Pneumothorax: (4) PMLP
PPV
Meconium aspiration
Lung deformities
Prematurity
If there is a sudden worsening in respiratory distress, providers should suspect ______
Pneumothorax
What study diagnosis pneumothorax?
Chest xray
Besides an X-ray how else can Pneumothorax be diagnosed?
Stethoscope and flashlight (decreased breath sounds, increased light penetration over affected area)
Decreased breath sounds, during PPV may not indicate pneumothorax because they are other causes for this, such as: (5)
Poor ventilation technique
Not properly placed ETT
Tracheal obstruction
CDH
Other
What can resolve small pneumothorax?
Supplemental oxygen therapy
A large pneumothorax may require a provider to
Place catheter into pleural space to draw off air
Where is the entry made to place catheter into plural space for pneumothorax?
Fourth intercostal space @ anterior axillary line or second intercostal space @ mid clavicular line
What size needle to use for putting catheter into plural space for pneumothorax?
18-20 gauge needle) catheter system just on the top of next rib
What way should the catheter be directed (pneumothorax)?
Directed upwards
If a catheter kit is not available what can be used in an emergency? (Pneumothorax)
Butterfly needle
When there is more definite treatment as far as pneumothorax goes and placing a catheter.. a ______ needs placed
Thoracostomy tube
Pleural effusion is
The presence of fluid in the pleural space
Presence of fluid in the pleural space can press on surrounding ______ and interfere with ______ & _______ efforts
Structures, breathing, ventilation
What a clue to identifying pleural effusion?
Generalized edema
Neonates with hydrops fetalis (severe abdominal swelling from edema, who are hard to ressusitate) are likely to have
Fluid in the pleural space
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?
Ultrasound, breath sounds will be diminished over effusion, xray
Can small pleural effusions resolve on their own?
Yes
Pleural effusions that’s causing baby to struggle to breathe can be treated how?
Inserting catheter into pleural space and draining off fluid
Where is entry made for catheter to drain a pleural effusion?
Entry is made at the 5th or 6th intercostal place along the posterior axillary line
What size needle for pleural effusion catheter?
18-20 gauge needle/catheter on top of next rib
What direction is the catheter positioned for pleural effusion?
Directed posterior
Should you save fluid from pleural effusion to send to lab?
Yes
What is Robin sequence also known as?
Pierre Robin syndrome
What does Robin Syndrome cause?
Lower jaw doesn’t develop properly in utero, a cleft palate
In Robin sequence, the underdeveloped mandible and surrounding tissues block ____
Pharyngeal airway
Robin sequence makes what type of masks difficult to insert during resuscitation?
ETT & LMA
How to diagnose Robin sequence?
Visual inspection
What way should a baby with Robin sequence be positioned for resuscitation? Why? If this doesn’t open airway then what?
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
Terminus (placement) of the ETT is not the in trachea but in the
Pharynx
Why is ETT placed with Robin sequence?
To open upper airway
(Robinson sequence) in severe cases of respiratory distress, make every effort to place a ________. This is usually easiest with baby in the prone position.
Laryngeal mask airway
Babies normal only breathe through their mouth when they are _____
Crying
Choanal atresia
Nasal airway is blocked by tissue in nasal cavity/upper pharynx
Babies with choanal atresia can only breathe effectively when _____
They’re crying
Why can it be difficult to detect choanal atresia?
There are no external signs of disease
What does a neonate with choanal atresia generally experience?
Cycles of oxygen destaturation, cyanosis (airway blocked)
(Crying opens the airway)
What can test for choanal atresia ?
A suction catheter gently applied through the nares into the posterior pharynx
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 ______
Choanal atresia
Definite diagnosis and treatment of ______ ; requires a specialist
Choanal atresia
What can you do to stabilize a baby with choanal atresia?
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.
A diaphragmatic hernia is usually diagnosed via sonogram @ how many weeks gestation?
18-22
Symptoms of CDH at birth are:
Diminished lung sounds
Respiratory distress
Tachycardia
Bowel sounds in chest
What type of ventilation should be avoided with babies who are born with CDH? And what should be done immediately?
Bag mask ventilation, they should be intubated
(CDH) In order to prevent intestinal distension and compression of the available lung tissue,what must be inserted?
And orogastric tube (used to deliver meds or food or remove contents)
Separate _______ and _______ should be placed while awaiting urgent pediatric surgery consultation and treatment.
Umbilical artery, vein catheters
Neonates with CDH are at high risk for ______ and will likely require ____, _____ &______
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)
Women who have taken opioids within 4 hours prior to delivery require ______
Special attention
Opioids depress the drive to breathe, so neonates with opioids on board may have _____
Impaired respiratory drive
How to treat baby with opioids on board?
Support with ventilation until baby metabolizes and clears the opioid. Once this happens baby should breathe spontaneously.
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)
Naloxone & other opioid receptor antigens. Could cause baby to have withdrawal seizures, pulmonary edema, & cardiac arrest
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 ____________
Cardiopulmonary impairment, But severe cardiac abnormalities can appear immediately.
When should congenital heart malformations be suspected?
When neonate is cyanotic(blue purple skin) and tachypneic (rapid breaths)
