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Interventions 2 (RESP 319) > Module 4 Manual Ventilation (Anatomy) > Flashcards

Module 4 Manual Ventilation (Anatomy) Flashcards

1
Q

What is the age range for: A neonate?

A

Younger than 30 days

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2
Q

What is the age range for: A young infant

A

30 days to 3 months

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3
Q

What is the age range for: a older infant

A

3 months to 1 year

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4
Q

What is the age range for: A child

A

1 year to adolescence

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5
Q

According airway management, What is the age range of: A neonate

A

younger than 30 days

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6
Q

According to airway management, What is the age range of: an infant?

A

30 days to 1 year

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7
Q

According to airway management, What is the age range of: A child?

A

1 year to 8 years of age
- This one is really important to know

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8
Q

According airway management, What is the age range of: A small adult?

A

Older than 8 years of age
- This one is important to know

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9
Q

Broselow tape, what group does a person fit if they don’t fit within it?

A
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10
Q

How does a child’s airway differ in the pharynx from an adults?

A

Children have comparively larger tonsils, tongues, and adenodids in relation to the size of their mouth

  • i.e Children’s tonsils take up more space in their mouth
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11
Q

What are some complications in a child’s pharynx compared to an adults?

A

When inflamed/swollen, they may obstruct the airway

  • may bleed easily
  • may collapse easily against posterior pharynx and obstruct airway
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12
Q

How does a child’s larynx differ from an adults?

A
  • Larynx is more funnel shaped
  • higher, more anterior glottis opening
  • Smaller cricothyroid membrane
  • Epiglottis is higher and angled away from long axis of trachea (meaning horizontal)
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13
Q

What are some complications with adolescent larynx’s?

A
  • Cricoid cartilage is narrowest part of the airway
  • harder to visualize vocal cords and intubate

-

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14
Q

In the larynx what is the narrowest part for adults?

A

glottis opening (rims glottis)

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15
Q

How does a child’s trachea differ from an adults?

A
  • Cartilage is less developed and more compliant
  • Mucosa more fragile
  • Angle of main stem bronchi is different
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16
Q

What are some complications in a child’s trachea?

A

More susceptible to:
- collapse w/higher WOB
- tearing, inflammation, and swelling
- bilateral aspiration pnemumonias are more likely

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17
Q

Add info from this slide later

A
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18
Q

What affects a baby’s heart rate during birth?

A
  • Contractions (depends where)
  • umbilical position
  • Inefficient umbilical cord
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19
Q

Complications for premature babies

A
  • Lungs deficient in surfactant
  • immature brain development
  • Weak muscles
  • Thin skin, large surface area
  • Infection risk
  • fragile blood supply
  • small blood volume
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20
Q

How do contractions affect a baby during labor?

A

Typically, a baby’s heart rate should increase slightly during a contraction and then return to its baseline between contractions.

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21
Q

What are implications of late decelerations in the babies heart during labour?
- Are they concerning?

A

They are concerning.

Late decelerations suggest the baby is not getting enough O2 during contractions, likely due to:

  • compression of the umbilical cord
  • inefficient placenta not providing enough blood flow
  • Uterine contractions are too intense or frequent
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22
Q

Generally, What do late decelerations in the babies heart indicate during labour?
- What are they?

A

Babies heart rate is slowing down after the peak of contraction.

  • They are a sign of fetal distress which may require intervention
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23
Q

what are interventions for late decelerations in a baby’s heart?

A
  • Changing the mothers position
  • O2 therapy to the mother
  • Adjusting the rate of IV fluids
  • Cesarean section (C-section) if babies distress is severe or persistent
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24
Q

What do early decelerations in a babies heart indicate?
- Are they concerning?
- What can they indicate?

A

They’re usually benign, associated w/head compression during contractions

  • They’re normal
  • Early decelerations mirror contractions. Meaning HR decreases at the same time as the mothers contractions (and recover at the same time).
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25
Q

What are variable decelerations?
- are they concerning?

A

Random drops in the babies HR (U or V appearance on a strip). They can be concerning depending if they persistent and their depth and duration are crazy long. They’re random events.

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26
Q

What could cause variable deceleration?

A
  • Umbilical cord compression
  • changes in fetal position
  • pressure on the umbilical cord during contractions
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27
Q

Maternal Conditions and risk factors?
edit slide 5 and 6, see if we need to know neonatal outcomes from the mothers conditions

A
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28
Q

How does O2 aid premature babies with surfactant deficiencies in the lungs?

A
  • O2 therapy increases O2 concentration in the bloodstream, which reduces the strain on the baby’s lungs and heart.
  • The lungs can function normally w/o risk of lung damage from the strain of laboured breathing (including RDS)
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29
Q

Why is thin skin on a premature baby concerning?

A

Poor ability to manage temperature, which can lead to hypothermia and eventual acidosis (breathing rate and depth decrease)

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30
Q

Why would you provide a premature baby caffeine?

A

Prevent apnea of prematurity, stimulation helps baby breath easier.

  • Caffeine also helps open airways and increase muscle tone in babies. Particularly important for babies with underdeveloped lungs and RDS
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31
Q

What is a normal RR in a newborn?

A

40-60

32
Q

when should CPAP be used on a baby?

A

Moderate to high WOB

33
Q

What are goals of oxygen therapy on a baby?

A

Target the lowest end of goals
- High PaO2 increases the risk of retinopathy
- Oxygen should always be humidified

34
Q

What are preductal SpO2 targets after birth?

A

ask someone later

35
Q

where do you place the sat probe on a neonate?

A

Right hand, either on palm of hand (ideal) or wrist

36
Q

What are oxygen goals for a neonate/newborn?

A

Target the lowest end of goals

  • high PaO2 increases the risk of retinopathy of prematurity
  • Oxygen should always be warmed and humidified
37
Q

What are pre-ductal SpO2 target ranges?

A
38
Q

Normal RR and HR for: Infants (< 1yr)

A

RR = 30-60

HR = 90-120

39
Q

Normal RR and HR for: Toddlers (1-3)

A

RR = 24-40

HR = 80-100

40
Q

Normal RR and HR for: Preschoolers (4-5)

A

RR = 22-34

HR = 70-90

41
Q

Normal RR and HR for: school age (6-12)

A

RR = 18-30

HR = 70-90

42
Q

Normal RR and HR for: Adolscent (13-18)

A

RR = 16-22

HR = 60-80

43
Q

What is a sign of respiratory distress in pediatrics and mature neonates?

A
  • Heading bobbing, apparently it helps oxygenation
  • Stridor
  • Retractions
  • nasal flaring
  • Grunting
44
Q

Review slide 27 in man.vent. B

A
45
Q

When assessing a newborn, what should you do in the first 30 seconds if dry stimulation doesn’t rouse the baby?

A

Attach SpO2 and ECG

46
Q

What should you do for a newborn if they have labored breathing and low SpO2?

A

Provide supplemental O2 and CPAP

47
Q

How do you provide supplemental O2 to a newborn?

A

Hover the mask above the babies face with any of the following:
- Free flow
- Flow inflating bagging unit
- Neopuff with mask

48
Q

What range can you set the blender?

A

anywhere between 21-30%
- However, keep it as low as possible.

49
Q

How do you provide CPAP on a newborn?
- what do you set your PEEP at?
- FiO2?

A

Use a. Neopuff & Flow inflating bagging unit to provide CPAP
- Keep PEEP at 5-6cmH2O to start
- FiO2 as required

50
Q

When do you initiate PPV on a newborn?

A

At the 30 sec evaluation if:
- Pt has not taken a breath
- Pt has ineffective respirations (or none)
- If HR is slowing down/close to 100 (or less)

51
Q

What is a basic requirement for the Neopuff, flow inflating bagger, and the self inflating bagger when used on newborns?

A

They all need to be attached to a blender

52
Q

What are the pros and Cons of a self inflating bagger?

A

Pros:
- Does not need a gas source
- Quick and easy to use

Cons:
- Often no pressure monitor so little to no control of pressures (including PEEP)

Insert image

53
Q

What are the pros and cons of a flow inflating bagger?

A

Pros:
- Good control of pressure (PEEP included)
- Ability to feel effective ventilation and volumes
- Can adjust pressures as needed to achieve chest movement
- Can provide CPAP

Cons:
- Slow initial breath (bag has to fill)
- irregular pressures and PEEP due to operator control
- Often inverse I:E ratios

insert image

54
Q

What are pros and cons of a NeoPuff/T Piece Resuscitator?

A

Pros:
- Precise control of peak pressures, PEEP, and the I:E Ratio
- Can provide CPAP

Cons:
- often not adjusted quickly to needed PIP to achieve chest movement

55
Q

What should correct mask placement have for newborns?

A

covering the nose and mouth without leaking out the sides (or being too big)

56
Q

Sniffing position on a newborn?

A
57
Q

What should your initial pressure be when setting up PPV for a newborn?

A
  • Blender @21% w/background flow of 10 LPM
  • PEEP @ 5 cmH2O
  • PIP @ 20 cmH2o
  • Max safety range of 40
58
Q

What should your pressure ratios be for newborns on PPV?

A

20/5 to start, adjust for adequate chest movement.

59
Q

How do you know if ventilation is ineffective in newborns?

A

Heart rate

Chest is moving, but HR is dropping/is low.

60
Q

Why would you need high pressures in neonatal lungs?

A

Fluid

61
Q

What is the rate of breaths you should provide a neonate?

A

40–60 BPMS

62
Q

What is the I:E Ratio for neonates?

A

Breath, two, three, Breath

63
Q

What should you do during your first PPV assessment?
- when should you check?

A

Check to see if the heart rate increases, decreases, or doesn’t change.
- First 15 seconds.

64
Q
A
  • Announce “HR is increasing”
  • Second HR assessment after another 15 seconds
65
Q

What should you do in your first assessment heart rate after 15 seconds of PPV if:
- HR doesn’t increase but the chest IS moving?

A
  • Announce “HR is not increase, but chest is moving”.
  • Continue PPV that moves the chest
  • Second HR assessment after another 15 seconds of PPV that moves the chest
66
Q

What should you do in your first assessment heart rate after 15 seconds of PPV if:
- HR does not increase and chest is not moving.

A
  • Announce “HR not increasing, no chest movement”
  • Ventilation corrective steps until chest movement w/PPV. Intubate or laryngeal mask if necessary
  • Announce when chest is moving.
  • Second HR assessment after 30 seconds of PPV that moves the chest
67
Q

What corrective steps should you follow for low HR and no chest movement

A

MR. SOPA

68
Q

If you need to increase pressure when supplying PPV, how much should you increase by?

A

5 to 10 cmH2O increments, Max 40.

69
Q

What should you do in your second heart assessment after 30 seconds of PPV if:
- HR at least 100 BPM?

A
  • Continue PPV 40-60 breaths per min until spontaneous effort
70
Q

What should you do in your second heart assessment after 30 seconds of PPV if:
- HR is 60-90 bpm

A

Reassess ventilation
- ventilation corrective steps if necessary.

71
Q

What should you do in your second heart assessment after 30 seconds of PPV if:
- <60 bpm

A
  • Reassess ventilation
  • Ventialtion corrective steps if necessary
  • Insert an alternative airway
  • If no improvement 100% O2 and chest compressions
72
Q

when would you increase FiO2 to 100%?

A

When chest compressions have started

73
Q

What should you do for a Pt with a HR <60, and effective PPV?

A

Increase their FiO2 (suggested 60%-100%)

74
Q

Why do you wan’t to avoid HME’s on neonates?

A

Adds increased deadspace
- only use when there is known history of maternal airborne illness
- place pt on heated humidified circuit ASAP

75
Q

Do pediatric airway management defer from adult management?

A

Not really, refer to the Broselow tape for equipment choice

76
Q

In neonates, what are critical indicators when bagging?

A
  • Chest rise
  • HR
  • SpO2

Interventions 2 (RESP 319) (25 decks)

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