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RT240 > Neonatal pulmonary pathologies/Resuscitation > Flashcards

Neonatal pulmonary pathologies/Resuscitation Flashcards

1
Q

What is persistent fetal circulation (PFC)?

A

This is postnatal persistence of right-to-left ductal or atrial shunting, or both in the presence of elevated right ventricular pressure.

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2
Q

What can PFC cause?

A

R to L shunts, severe hypoxemia and cyanosis, ductus arteriosus and foramen ovale failing or reopening.

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3
Q

List some clinical presentations of PFC.

A

Cyanosis, tachypnea, acidemia, hypoxemia, ad pre-ductal and post-ductal ABG comparison.

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4
Q

How is PFC treated?

A

Pulmonary vascular resistance is reduced by hyperoxygenation. Tolazoline also known as priscoline is also used.

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5
Q

What causes IRDS?

A

reduction in lung volume due to lack of surfactant production(particularly mature surfactant)

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6
Q

Which of these are clinical presentations of IRDS?
1.Hypoxemia
2.High APGAR score
3.Bradypnea
4.Cyanosis
5.Bat wings on CXR

A

1 and 4. The APGAR score will be low, the pt will be tachypneic, and bat wings are associated with pulmonary edema. In this case the CXR will show reticulogranular infiltrates or a ground glass appearance.

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7
Q

What will am CXR with IRDS look like?

A

reticulogranular infiltrates or a ground glass appearance.

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8
Q

What is the main goal of treating IRDS?

A

to prevent alveolar collapse.

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9
Q

Fill in the blank in regards to treating IRDS:
a. Treat hypoxemia with ____ and ____.
b. Treat respiratory failure with _____ _______ and _____.
Before the birth give the mother ______ to stimulate ________ production.

A

a. Oxygen, CPAP
b. mechanical ventilation, PEEP
c. steroids, surfactant

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10
Q

T or F?
IRDS can be treated by administering surfactant.

A

True

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11
Q

What is transient tachypnea of the newborn(TTN) usually caused by?

A

C-section delivery, the baby does not receive that thoracic squeeze to help force fluid out of the lungs.

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12
Q

How long does symptoms of TTN usually occur? What is the duration?

A

12-24h after birth, last around 24h

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13
Q

List a few clinical presentations of TTN.

A

Tachypnea, cyanosis, nasal flaring, grunting, and minimal retractions.

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14
Q

T or F in regards to TTN.

a. TTN can be caused by low absorption of excess amounts of lung fluid.
b. APGAR scores are bad at birth and within 12-24h the newborn develops some respiratory difficulty.

A

a. true
b. false, APGAR scores are good at birth

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15
Q

What are some ways that TTN is treated?

A

TTN can be treated with supplemental oxygen, CPAP, and CPT/PD

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16
Q

What is a congenital diaphragmatic hernia and how does it occur?

A

Results from one or part of one hemidiaphragm absent, allowing the abdominal organs to enter the chest cavity.

17
Q

___% of the time congenital diaphragmatic hernias occur on the left side.

A

90

18
Q

T or F?
Congenital diaphragmatic hernias are usually resolved and aren’t considered to be of an emergency.

A

FALSE!!
This is always considered to be an emergency and immediate surgical correction is required.

19
Q

What can cause retinopathy of prematurity(ROP)?

A

long exposure to high percentages of oxygen.

20
Q

How can ROP be prevented?

A

Maintain PaO2 levels in the safe range of 55-75mmHg and reduce the amount of the exposure to high FiO2.

21
Q

NRP stated: “if at birth, the infant is _____ or the infants HR is less than ___, positive pressure ventilation is the most important step in CPR of a compromised newborn.

A

apneic, 100

22
Q

Fill in the blank in regards to pulmonary resuscitation
a. Size of bag should be no larger than ____ ml.
b. Newborn bag should be between ___ and ___ml.
c. ___ to __ ml per ventilation.
d. The mask should cover their ____ and ___ but not their ____.

A

a. 750
b. 200 and 750
c. 15-25ml
d. Mask should cover their mouth and nose but not the eyes.

23
Q

The neonates jaw is usually moved upward and away from the neck with the usage of a?

A

Towel underneath the shoulders

24
Q

The neonate is ventilated at a rate of __ to __ bpm.

A

40-60

25
Q

What can be used to help avoid giving too large of a breath?

A

A pressure manometer.

26
Q

Fill in the blank in regards to size of breaths.
a. Initial breaths after delivery should be over __ cmH2O.
b. Normal lungs are usually between __ to __cmH2O.
c. Diseased or immature lungs give about __ to __cmH2O.

A

a. 30
b. 15-20
c.20-40

27
Q

When is intubation usually done?

A

When the HR is less than 100 bpm, APGAR score is less than 2, birthweight is low, infant is unresponsive to bag and mask ventilation, transport of unstable newborn is required, and for meconium.

28
Q

T or F?
An ETT tube can act as a route of administration of epinephrine.

A

True

29
Q

ETT tubes smaller than ___ mm should not be used because of the high resistance to flow.

A

2.5

30
Q

What is the #1 indicator of proper placement of the endotracheal tube in an neonate.

A

Positive color change

31
Q

Chest compressions should be initiated when the HR is less than __ bpm with __ to __ seconds of positive pressure ventilation with ____ oxygen.

A

60, 10-30, 100%

32
Q

What is another reason that chest compressions may need to be initiated?

A

When there is no heart rate.

33
Q

What is the best treatment for brief periods of bradycardia?

A

ventilation and possibly oxygen

34
Q

What medications may be used during cardiopulmonary stress if there is no improvement of the heart rate and ventilation of the newborn?

A

Epinephrine, volume expanders, sodium bicarbonate, naloxone(narcan), and dopamine.

35
Q

Why should hyperextension of the neck be avoided during neonatal resuscitation?

A

Hyperextension should be avoided to prevent collapse of the soft cartilage or the larynx which should cause upper airway blockage

36
Q

List the estimation of ETT tube sizes based off the neonates weight. Correlate the correct suction catheter size with the tube size too.
Less than 1000g =
1000 to 2000g =
2000 to 3000g=
3000 to 4000g=

A

Less than 1000g = 2.5, 5 or 6 Fr
1000 to 2000g = 3.0, 6 or 8 Fr
2000 to 3000g= 3.5 8 Fr
3000 to 4000g=4.0 8 or 10Fr

37
Q

What is the formula used to determine tip to lip depth placement of a ETT tube?

A

Baby’s weight in kg + 6

38
Q

Using the “tip to lip” formula. List the correct depth range for a baby that weighs:
a. Under 1 kg
b. 1kg
c. 2 kg
d. 3 kg
e. 4kg

A

A. 6cm
B. 7cm
C. 8cm
D. 9cm
E. 10cm

RT240 (5 decks)

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