Module 4 Manual Ventilation (Anatomy) Flashcards
What is the age range for: A neonate?
Younger than 30 days
What is the age range for: A young infant
30 days to 3 months
What is the age range for: a older infant
3 months to 1 year
What is the age range for: A child
1 year to adolescence
According airway management, What is the age range of: A neonate
younger than 30 days
According to airway management, What is the age range of: an infant?
30 days to 1 year
According to airway management, What is the age range of: A child?
1 year to 8 years of age
- This one is really important to know
According airway management, What is the age range of: A small adult?
Older than 8 years of age
- This one is important to know
Broselow tape, what group does a person fit if they don’t fit within it?
How does a child’s airway differ in the pharynx from an adults?
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
What are some complications in a child’s pharynx compared to an adults?
When inflamed/swollen, they may obstruct the airway
- may bleed easily
- may collapse easily against posterior pharynx and obstruct airway
How does a child’s larynx differ from an adults?
- 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)
What are some complications with adolescent larynx’s?
- Cricoid cartilage is narrowest part of the airway
- harder to visualize vocal cords and intubate
-
In the larynx what is the narrowest part for adults?
glottis opening (rims glottis)
How does a child’s trachea differ from an adults?
- Cartilage is less developed and more compliant
- Mucosa more fragile
- Angle of main stem bronchi is different
What are some complications in a child’s trachea?
More susceptible to:
- collapse w/higher WOB
- tearing, inflammation, and swelling
- bilateral aspiration pnemumonias are more likely
Add info from this slide later
What affects a baby’s heart rate during birth?
- Contractions (depends where)
- umbilical position
- Inefficient umbilical cord
Complications for premature babies
- Lungs deficient in surfactant
- immature brain development
- Weak muscles
- Thin skin, large surface area
- Infection risk
- fragile blood supply
- small blood volume
How do contractions affect a baby during labor?
Typically, a baby’s heart rate should increase slightly during a contraction and then return to its baseline between contractions.
What are implications of late decelerations in the babies heart during labour?
- Are they concerning?
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
Generally, What do late decelerations in the babies heart indicate during labour?
- What are they?
Babies heart rate is slowing down after the peak of contraction.
- They are a sign of fetal distress which may require intervention
what are interventions for late decelerations in a baby’s heart?
- 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
What do early decelerations in a babies heart indicate?
- Are they concerning?
- What can they indicate?
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).
What are variable decelerations?
- are they concerning?
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.
What could cause variable deceleration?
- Umbilical cord compression
- changes in fetal position
- pressure on the umbilical cord during contractions
Maternal Conditions and risk factors?
edit slide 5 and 6, see if we need to know neonatal outcomes from the mothers conditions
How does O2 aid premature babies with surfactant deficiencies in the lungs?
- 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)
Why is thin skin on a premature baby concerning?
Poor ability to manage temperature, which can lead to hypothermia and eventual acidosis (breathing rate and depth decrease)
Why would you provide a premature baby caffeine?
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
What is a normal RR in a newborn?
40-60
when should CPAP be used on a baby?
Moderate to high WOB
What are goals of oxygen therapy on a baby?
Target the lowest end of goals
- High PaO2 increases the risk of retinopathy
- Oxygen should always be humidified
What are preductal SpO2 targets after birth?
ask someone later
where do you place the sat probe on a neonate?
Right hand, either on palm of hand (ideal) or wrist
What are oxygen goals for a neonate/newborn?
Target the lowest end of goals
- high PaO2 increases the risk of retinopathy of prematurity
- Oxygen should always be warmed and humidified
What are pre-ductal SpO2 target ranges?
Normal RR and HR for: Infants (< 1yr)
RR = 30-60
HR = 90-120
Normal RR and HR for: Toddlers (1-3)
RR = 24-40
HR = 80-100
Normal RR and HR for: Preschoolers (4-5)
RR = 22-34
HR = 70-90
Normal RR and HR for: school age (6-12)
RR = 18-30
HR = 70-90
Normal RR and HR for: Adolscent (13-18)
RR = 16-22
HR = 60-80
What is a sign of respiratory distress in pediatrics and mature neonates?
- Heading bobbing, apparently it helps oxygenation
- Stridor
- Retractions
- nasal flaring
- Grunting
Review slide 27 in man.vent. B
When assessing a newborn, what should you do in the first 30 seconds if dry stimulation doesn’t rouse the baby?
Attach SpO2 and ECG
What should you do for a newborn if they have labored breathing and low SpO2?
Provide supplemental O2 and CPAP
How do you provide supplemental O2 to a newborn?
Hover the mask above the babies face with any of the following:
- Free flow
- Flow inflating bagging unit
- Neopuff with mask
What range can you set the blender?
anywhere between 21-30%
- However, keep it as low as possible.
How do you provide CPAP on a newborn?
- what do you set your PEEP at?
- FiO2?
Use a. Neopuff & Flow inflating bagging unit to provide CPAP
- Keep PEEP at 5-6cmH2O to start
- FiO2 as required
When do you initiate PPV on a newborn?
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)
What is a basic requirement for the Neopuff, flow inflating bagger, and the self inflating bagger when used on newborns?
They all need to be attached to a blender
What are the pros and Cons of a self inflating bagger?
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
What are the pros and cons of a flow inflating bagger?
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
What are pros and cons of a NeoPuff/T Piece Resuscitator?
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
What should correct mask placement have for newborns?
covering the nose and mouth without leaking out the sides (or being too big)
Sniffing position on a newborn?
What should your initial pressure be when setting up PPV for a newborn?
- Blender @21% w/background flow of 10 LPM
- PEEP @ 5 cmH2O
- PIP @ 20 cmH2o
- Max safety range of 40
What should your pressure ratios be for newborns on PPV?
20/5 to start, adjust for adequate chest movement.
How do you know if ventilation is ineffective in newborns?
Heart rate
Chest is moving, but HR is dropping/is low.
Why would you need high pressures in neonatal lungs?
Fluid
What is the rate of breaths you should provide a neonate?
40–60 BPMS
What is the I:E Ratio for neonates?
Breath, two, three, Breath
What should you do during your first PPV assessment?
- when should you check?
Check to see if the heart rate increases, decreases, or doesn’t change.
- First 15 seconds.
- Announce “HR is increasing”
- Second HR assessment after another 15 seconds
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?
- 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
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.
- 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
What corrective steps should you follow for low HR and no chest movement
MR. SOPA
If you need to increase pressure when supplying PPV, how much should you increase by?
5 to 10 cmH2O increments, Max 40.
What should you do in your second heart assessment after 30 seconds of PPV if:
- HR at least 100 BPM?
- Continue PPV 40-60 breaths per min until spontaneous effort
What should you do in your second heart assessment after 30 seconds of PPV if:
- HR is 60-90 bpm
Reassess ventilation
- ventilation corrective steps if necessary.
What should you do in your second heart assessment after 30 seconds of PPV if:
- <60 bpm
- Reassess ventilation
- Ventialtion corrective steps if necessary
- Insert an alternative airway
- If no improvement 100% O2 and chest compressions
when would you increase FiO2 to 100%?
When chest compressions have started
What should you do for a Pt with a HR <60, and effective PPV?
Increase their FiO2 (suggested 60%-100%)
Why do you wan’t to avoid HME’s on neonates?
Adds increased deadspace
- only use when there is known history of maternal airborne illness
- place pt on heated humidified circuit ASAP
Do pediatric airway management defer from adult management?
Not really, refer to the Broselow tape for equipment choice
In neonates, what are critical indicators when bagging?
- Chest rise
- HR
- SpO2
