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Residency > Neonatal Resuscitation > Flashcards

Neonatal Resuscitation Flashcards

1
Q

What is the required rapid initial evaluation for all newborns

A

Term?
Tone?
Breathing or Crying?

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2
Q

Next step if newborn baby is not term, has poor tone or is not breathing or crying?

A

Brought to radiant warmer for the initial steps of newborn care

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3
Q

What are the five initial steps of newborn care

A 
provide warmth
position the head and neck
clear secretions
dry
stimulate
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4
Q

After initial steps of newborn care (warmth, position, secretions, dry, stimulate), what are further decisions based on?

A

Breathing and heart rate

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5
Q

At what point is a pulse oximeter or electronic cardiac (ECG) monitor be placed on a newborn baby?

A

If heart rate cannot be determined by listening with a stethoscope and baby is not vigorous

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6
Q

What should be used to confirm you perception of persistent central cyanosis, if you are giving supplemental oxygen to an newborn baby?

A

Target oxygen saturation table to guide oxygen therapy NOT the appearance of cyanosis

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7
Q

When is CPAP helpful in a newborn baby?

A

When breathing and heart rate is at least 100 beats/min, but respirations are labored or the oxygen saturations remains below the target.

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8
Q

After completing the initial steps, under what circumstances is positive-pressure ventilation indicated

A

Not breathing OR Gasping OR <100 beats/min OR oxygen not at target with free flow air

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9
Q

Initial oxygen percent for baby on PPV equal to or greater than 35 weeks gestation

A

21%

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10
Q

Initial oxygen percent for baby on PPV less than 35 weeks gestation

A

21-30%

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11
Q

Ventilation rate for PPV for newborn

A

40-60 breaths per minute

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12
Q

Initial ventilation pressure for PPV of a newborn

A

20-25 cm H2O

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13
Q

Most important indicator of successful PPV is

A

a rising heart rate

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14
Q

When to check heart rate after starting PPV in a newborn

A

15 seconds

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15
Q

When are ventilation corrective steps started in a newborn

A

If heart rate does not increase after 15 seconds of PPV and no chest movement

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16
Q

What are the ventilation corrective steps if heart rate does not increase after 15 seconds of PPV and no chest movement for a newborn

A

MR. SOPA

M: Mask adjustment
R: Reposition the head

S: Suction mouth and nose
O: Open the mouth
P: Pressure increase
A: Alternative airway

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17
Q

What is the pressure increase in ventilation corrective steps for a newborn with no increase in HR after PPV

A

5-10 cm H2O increments to maximum of 40

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18
Q

When can PPV be discontinued in a newborn (reducing rate and pressure)

A

HR continuously above 100 with spontaneous breathing

Use CPAP or free-flow air to maintain oxygen after if needed

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19
Q

When is orogastric tube used with newborn on continuous CPAP or PPV?

A

after 10 minutes of use

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20
Q

Appropriate laryngoscope blade for a term newborn is size

A

No. 1

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21
Q

Appropriate laryngoscope blade for a preterm newborn is size

A

No. 0

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22
Q

How to determine endotracheal tube insertion depth (cm)

A

NTL (distance from nasal septum to ear tragus) + 1 cm or gestational age (add decimal)

23
Q

When are chest compression indicated in a newborn

A

HR remains < 60 despite 30 seconds of PPV, but if chest is not moving with PPV don’t start compression, focus on effective ventilation

24
Q

Compression to breaths ratio for newborn resuscitation

A

3 compression to 1 breath

Rhythm: “one-and-two-and-three-and-breath-and”

25
Q

When to discontinue compressions during resuscitation of a newborn

A

If HR is > 60, but continue breathing

26
Q

When is a newborn given epinephrine with resuscitation

A

HR < 60 after

  • At least 30 sec successful PPV
  • And another 60 seconds chest compressions with PPV (100% O2)
27
Q

Newborn epinephrine concentration for resuscitation

A

0.1 mg/mL

28
Q

Newborn epinephrine intravenous or intraosseous dosage for resuscitation

A

0.1 - 0.3 mL/kg may repeat every 3-5 minutes

29
Q

Newborn epinephrine endotracheal dosage for resuscitation

A

0.5 - 1.0 mL/kg

30
Q

Volume expansion recommendations for newborn resuscitation

A

NS or type-O Rh-negative blood

10 ml/kg over 5-10 minutes

31
Q

Post-resuscitation care of a newborn infant, need what type of close monitoring

A 
Respiratory effort
Oxygenation
Blood pressure
Blood glucose
Electrolytes
Urine output
Neurologic status
Temperature
32
Q

Where on newborn baby is pulse oximeter placed

A

right hand

33
Q

Type of bag that do not require a compressed gas source

A

Self-inflating bags

34
Q

Type of bag that cannot be used to administer free-flow oxygen reliably through the mask

A

Self-inflating bags

35
Q

The type of bag that cannot be used to administer CPAP to a spontaneously breathing baby

A

Self-inflating bags

36
Q

Type of breather that require a compressed gas source

A

Flow-inflating bags and T-piece resuscitator

37
Q

Type of bag that must have a tight seal to inflate

A

Flow-inflating bags

38
Q

Type of bags that use a flow-control valve to regulate the peak inspiratory pressure (PIP) and positive-end expiratory pressure (PEEP)

A

Flow-inflating bags

39
Q

Type of device that can be used to administer free-flow oxygen through the mask

A

Flow-inflating bags and T-piece resuscitators

40
Q

What type of breathing devices be used for newborns for administration of CPAP to a spontaneously breathing baby

A

Flow-inflating bags

41
Q

For babies weighting less than 1,000 g, the endotracheal tube diameter size should be

A

2.5 mm

42
Q

Suspect what if a baby fails to improve despite resuscitative measures or suddenly develops severe respiratory distress

A

Pneumothorax

43
Q

Suspect what if a newborn has respiratory distress and generalized edema (hydrops fetalis)

A

Pleural effusion

44
Q

Robin sequence

A

abnormalities such as small lower jaw (micrognathia), a tongue that is place further bak than normal (glossoptosis), and blockage (obstruction) of the airways

45
Q

Respiratory distress associated with the Robin sequence can be improved by

A

Placing the baby prone and inserting small endotracheal tube (2.5 mm) into the nose so the tip is in the pharynx

46
Q

If a small endotracheal tube does not improve respiratory distress of a newborn with Robin sequence, what is next step

A

A laryngeal mask may provide a lifesaving airway. (endotracheal intubation is frequently difficult)

47
Q

How to improve respiratory distress associated with bilateral choanal atresia

A

Inserting modified feeding nipple or pacifier with the end cut off into the baby’s mouth, an endotracheal tube into the mouth with the tip in the posterior pharynx, or an oral (Guedel) airway

48
Q

If a congenital diaphragmatic hernia is suspected for a delivery, what should be avoided following delivery

A

Avoid prolonged PPV with a face mask

49
Q

If a congenital diaphragmatic hernia is suspected for a delivery, what is first step after delivery

A

Quickly intubate the trachea in the delivery room and insert an orogastric tube with suction to decompress the stomach and intestines

50
Q

Potential benefits of delayed cord clamping for preterm newborns include

A 
Decreased mortality
Higher blood pressure and blood volume
Less need for blood transfusion after birth
Fewer brain hemorrhages
Lower risk of necrotizing enterocolitis
51
Q

Indications for volume expansion for newborn after resuscitative efforts that included intubation, chest compression, and IV epinephrine

A

persistently low heart rate that does not respond to previous mentioned things

52
Q

After chest compression with coordinated ventilations are started in a newborn, the heart rate should be assessed (time)

A

After 60 seconds

53
Q

When is heart rate assessed again after epinephrine administration in a newborn

A

1 minute

Residency (5 decks)

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