NERPS Flashcards
What % of newborns require SOME breathing assistance?
10%
What percent of new borns require extensive resuscitative efforts?
1%
Birth Asphyxia rates
23% of neonatal deaths each year world wide
What 3 questions need to be asked initially for good neonatal functioning
Term gestation?
Breathing or crying?
Good tone?
The most important and effective action in neonatal resuscitation?
Ventilating the babies lungs
Before birth the babies lungs are filled with
Fluid and expanded
If the baby does not begin breathing in response to stimulation they are assumed to be in ________and ___________ should be provided
Secondary Apnea
Positive pressure Ventilation PPV
If the baby is in secondary apnea then the pulse will subsequently _________ and the blood pressure will _________
Fall
And
Fall
We can know that the baby’s adequate ventilation is restored when
The pulse improves rapidly
Premature babies and some risks associated.
Any baby born before 37 completed weeks of gestation
- lungs deficient in surfactant
- immature brain development
- weak muscles (spontaneous breathing more difficult)
- thin skin
- high likelihood of infection
- fragile blood vessels in brain
- small blood volume (Hypovolemia)
- immature tissues
Targeted pre-ductal spo2 levels after birth
1 min= 60-65 2min= 65-70 3min= 70-75 4min= 75-80 5min= 80-85 10min= 85-95
Pre ductal spo2 @ 1min
60-65
Pre ductal spo2 @ 2 min
65-70
Pre ductal spo2 @ 3 min
70-75
Pre ductal spo2 @ 4min
75-80
Pre ductal spo2 @ 5min
80-85
Pre ductal spo2 @ 10min
85-95
When deciding which babies are “vigorous” what 3 characteristics are needed?
Good Breathing
Good Muscle Tone
HR above 100
What size of catheter is needed to clear the oropharynx before inserting a ET tube?
12-14 French
The newborn is covered in meconium, is breathing well, has normal muscle tone, has a heart rate of 120, and is pink. What is the correct action for suctioning?
Suction the mouth and nose with a bulb syringe or suction catheter.
A new born is still not breathing after a few seconds of stimulation. What is the next action?
Administer PPV
You have stimulated a new born and suctioned their mouth. It is now 30 seconds after birth, and she is still apneic and pale. Her heart rate is 80. Your next action is
Provide PPV
MR SOPA
Mask seal
Reposition Airway
Suction Mouth and nose
Open Mouth
Pressure Increase
Airway Adjunct (alternative)
Full term in weeks
End of 27-40
APGAR
Appearance
Pulse
Grimace
Activity
Respirations
Fluid replacement amount in neonates
10ml/kg over 5-10 mins
Measuring OG tubes in neonates
Measure the distance from the nose to the earlobe and then from the earlobe to a point halfway between the xiphoid process and the umbilicus
Size of OG tube
8F
How far should a OG tube be inserted (cm)
22
Assisted ventilation may be discontinued when:
Heart rate is above 100bpm
Sustained spontaneous breathing is present
Hold resuscitation device so you can see the newborns_________
Chest and abdomen
A baby is born apneic and cynotic. You clear the airway and stimulate. Thirty seconds after birth the baby has not improved, the next step is to
Begin PPV
Self inflating bags require the attachment of _________________ to deliver a high concentration of oxygen.
Oxygen reservoir
Principle safety features of FLOW INFLATING bags
Pop off valve
Pressure gauge
Principle safety features of SELF INFLATING BAGS
Pressure gauge
Principle safety features of T PIECE RESUCITATOR
Maximum pressure relief control
Pressure gauge
PPV rates for ventilation neo nates
40-60 breaths per minute
Begin PPV with an initial inspiratory pressure of ___________
20 cm of water
Assess PPV BY ____________ and ____________ then listening for _________________. If these signs are unacceptable then look for ________________
HR and SPo2
Lung sounds
Chest rise
After 30 second of PPV what do you do if the babies HR is below 60
Begin chest compressions and consider intubation
After 30 seconds of PPV you babies HR is greater than 60 but less than 100 but steadily improving. What do you do?
Adjust oxygen, gradually decrease pressure as rate improves, insert OG and continue monitoring
After 30 seconds of PPV the babies HR is above 60 but less than 100 and not improving. What should be done?
Do MR SOPA and consider intubation
The preferred chest compression technique is
The thumb technique
The correct depth of compressions is
One third of the anterior-posterior diameter of the chest
Compression area of neo nate chest
Lower third of the sternum between the xyphoid process and a line drawn between the nipples
Ratio for compressions to breaths
3:1
The rate of ventilations without chest compressions is
40-60
There should be how many “events” during chest compressions?
120
The three compressions and one breath should take
2 seconds
Size of ET tube for babies below 1000g or below 28 weeks
2.5
ET tube size for baby between 1000-2000g or 28-34 weeks
3.0
ET tube size for baby 2000-3000g or 34-38 weeks
3.5
ET tube size for baby above 3000g or above 38 weeks
3.5-4.0
The neonatal intubation procedure should take more than
30 seconds
Neonate intubation steps
- Stabilize head in sniffing position
- slide laryngoscope on right to left.
- lift blade
- look for landmarks
- Insert tube
- if chords closed wait for them to open
- brace tube against hard palate
Useful situations for LMA
Facial or upper airway malformations render ventilation by mask ineffective
Iff PPV not working and ET intubation not possible.
Fewer than what percent of babies need Epi to stimulate their hearts
1%
Effective ventilation and coordinated chest compressions have been preformed for 45-60 seconds, the trachea has been intubated, and the baby’s heart rate is below 60 beats per minute. You should now ______________ while continuing chest compressions and ________________
Give epinephrine
Ventilation
What is the potential problem with administering Epi through an endotracheal tube?
Epi is not reliably absorbed in the lungs. A higher dose (0.5-1ml/kg) should be considered.
The recomended dose of epi for new borns is _________ to __________ml/kg IV or __________ to __________ml/kg ET
- 1-0.3 ml/kg IV
0. 5-1.0 ml/kg ET
If the neo nate appears to be in shock there is evidence of blood loss. And resuscitation is not resulting in improvement, you should consider giving _____________ via _____________
10ml/kg of volume expanders via umbilical vein
Therapeutic hypothermia in neonates
33.5-34.5 c
Choanal Atresia can be ruled out by what procedure?
Passing a NPA through the nares to assess for obstruction of the skull
Babies with robin syndrome who have upper airway obstruction may be helped by placing a ___________ and positioning them ______________. Endotracheal of such babies is usually _______
Nasopharyngeal tube
Prone on their abdomen
Difficult
You should suspect a congenital diaphragmatic hernia if ___________. Such babies should not be resuscitated with _____________.
Flat appearing scaphoid abdomen present
PPV by mask
