Neonatal resuscitation Flashcards
Determinants of anticipation of resuscitation
Was baby delivered at term?
Is baby crying or breathing?
Does baby have good muscle tone?
Prevailing room temperature for resuscitation
Greater or equal to 26C
How many cot sheets needed
at least 3
Apgar score done at which time intervals
1st and 5th mins
Apgar score
- Excellent
- Moderate
- Severe
- Excellent - 7-10
- Moderate 4 - 6
- Severe 0-3
Significance of golden minute
Baby should be breathing by the end of the 1st minute of liffe
Order of suctioning of mouth and nose
Suction mouth before nose
Is suctioning routine
NO
If secretions are a lot, to which direction do you tilt the baby
to the right
Significance of CE grip
C grip - BVM mask
E grip - maintains sniffing position
Position of Middle and last two fingers in the E grip
middle- chin
last 2 - along jaw bone
What ideal respiratory rate of a new born does one seek to achieve during the resuscitation
40 - 60 cycles per min
When to start chest compression
when pulse rate is less than or equal to 60bpm
Best way to provide extra warmth for resuscitation besides wrapping and drying
via the radiant warmer
Significance of AGPAR score
Although the APGAR score is not used as a decision making tool, it can be of value in assessing the progress of the resuscitation.
Indications for providing positive pressure ventilation
apnea, gasping and heart rate < 100bpm
Reasons chest may not rise with ventilation include:
wrong ambu bag placement
components of ambu bag are not properly connected, splinting of diaphragm by air leakage into stomach, obstructed airway
Ways of improving ventilation
Mask readjustment
Reposition airway
Suction mouth and nose
Open mouth
Pressure increase
Alternative airway
Compression to respiraration ratio
3: 1
90 compressions and 30 ventilations
120 activities in one minute
When to discontinue chest compression
Above 60 bpm
Where exactly on the chest are the compressions done?
Performed halfway at the lower third of sternum or moving 1cm below an imaginary line drawn through the nipples.
When to start adminstration of drugs
If heart rate remains < 60bpm in spite of 1 minute of effective/efficient PPV combined with chest compressions
Dose of adrenaline given
Administer 0.1-0.3 ml/kg of adrenaline (1 in 10,000)
Mode of adminstration of adrenaline
Given IV, preferably via umbilical catheter; can also be given via endotracheal tube.
When to repeat dose of adrenaline
Dose can be repeated every 3 to 5 minutes if heart rate is still less than 60bpm.
Indication of normal saline and dose
Indicated for new-borns not responding to resuscitation and showing signs similar to shock.
10ml/kg over 5-10 mins
When dextrose is given
10% dextrose can be given in cases of hypoglycemia (blood glucose < 2.6mmol/L).
2ml/kg IV followed by continuous infusion.
Reduces risk of adverse neurologic outcomes.
When should resuscitation be stopped?
Resuscitation should only be stopped when the neonate is not breathing and the heart rate is undetectable for at least 10 minutes
