Neonatal resuscitation base week 3 Flashcards
Fetal circulation:
Unique - 3 shunts - allows for redirection of blood
What are the 3 shunts? and what do they bypass?
Ductus venosum: - IVC
Fetal Heart structure
Due to these differences, the fetal heart has a number of different structures to direct blood flow:
The umbilical vein delivers oxygenated blood from the placenta to the fetus, providing oxygen and nutrients.
The umbilical arteries are used to transport deoxygenated blood away from the fetal tissue and back towards the placenta for re-oxygenation.
The ductus venosus allows blood from the placenta to bypass the highly demanding, but relatively inactive liver.
The ductus arteriosus is the fusion of the primitive pulmonary artery to the aorta, therefore allowing blood to pass straight from the right ventricle into the aorta and bypass the inactive lungs.
The foramen ovale creates a shunt between the right atrium and the left atrium so oxygenated blood from the placenta can move to the left atrium. This allows for the oxygenated blood to pass through the left ventricle and into the ascending aorta, oxygenating the brain.
FEtal lungs and circulation:
Pulmonary vascular resistance is high in utero:
Fetal circulation:
High I2 reaches brain and myocardium
Low 02 reaches placenta through umbilical arteries
The transition to out of utero life:
Respiratory
Circulatory
(two main differences)
At birth: What happens to lungs? What happens to heart?
Neonatal transition:
Pulmonary vascular resistance is high in utero:
Immediatley after burth, PVR decreases and continues to do so for 3 months:
The decrease in PVR leads to increase in pulmonary blood flow!!! need to understand this
Summary of fetal vs circulation at birth:
Describe the transitions that occur in the following:
- What happens at the placenta?
- The foramen ovale?
- Ductus arterious?
- Aorta?
- Lungs?
Newborn life support: Algorithmn:
Based on QCH:
Read step by step —- to understand
The most emphasise is on breathing:
What are the two major functions of the respiratory
- Exchange o2 in and out
- the avolus is the basic unit of respiration
Inspirations - Oxygenation
Expirations - ventilation (exhaling out- elimination of Co2)
GAs exchange principles:
In practise:
Premature lungs?
What occurs?
Important to understand: Lung Hysteresis loop:
Read
(need PEEP) to maintain your lungs to stay open: Need to understand this
PEEP- Allows for maximum recruitment of alveoli- and increases TV
What are the three major controls of respiratory system?
- MEchanics (phsyiological)
- Neurological - Brainstem - (very immature in preterm infants - predisposes to apnoea)
- Chemical process (aortic body, carotid bodies- Acid base status (ph) + c02 + Body temperature) )
Spontaneous breathing:
Time on X axis
Time, flow, volume on Y axis:
Inspiration is active (negative pressure) - allows for flow of gas into lungs
Expiration: Elastic recoil of lungs and intercostal muscles.
Spontaneous breathing:
NEgative pressure gradient needs to generated by downward movement of diaphragm
Crying newborn:
What phase of breathing is crying?
Expiration phase:
Vibrating vocal cords - this means they will only produce sound in the expiratory phase:
Active phase of respiration occurs in crying singing etc.
Spontaneous breathing:
What are the differences in pressure?
FLow?
VOlume? During crying:
TEHY ALL INCREASE!
IMportant: Comparison of lung volumes during crying, inspiration/expiration (crying)
Inspiration that precedes crying:
Crying:
Crying is the best indicator of infant breathing effectively:
Crying has physiological and neurophysiological usefullness:
Babies survive with the help of their first cry:
If patient is unable to breath and cry- Then need to add Positive end expiratory pressure- so you can maitain alveoli recruitment:
PIP- Then gives PEEP!!!!!
What is crying? (need to understand this slide)
What does it serve to do? (generate more PEEP and push out alveoli fluid)
FLuid replaced by air !
Decreasing pulmonary resistance by increasing pulmonary blood flow:
Neonatal resus:
What occurs at birth
What changes occur in the lungs?
What changes occur in the heart?
What are the 3 key components of neonatal resusitation:
1) Anticipate
2) Assess
3) Action
Newborn Life support:
Read:!!!!
Neonatal resusitation:
Key points
Read:!
Initial evaluation:
What would you ask?
What are routine cares to provide?
If abnormal what to do?
Secondary evaluation:
Secondary evaluation: For drop in HR what to do?
Key behavioural skills in simulation based training:
Neonatal resus principles:
T ABCD
Temperature: Secondary survery
Airway:
Breathing: Secondary survey
Breathing continued:
Neonatal Resus: Where to place oximetry probe?
Neonatal resus: trouble shooting for effecitve inflation by mask and T piece “Mr SOPA
NEonatal resus: Action:
Neonatal resus:
Neonatal resus:
Neonatal resus: MEconium:
Alveolar surface tension and surfactant: Role in newborn
