NLS revision Flashcards
What is the total volume of fluid produced by the lungs?
20-30ml/kg
Which substances are released by the fetus and mother in labour to help cease production of fluid in the lungs?
Adrenaline in the fetus
Thyrotropin release hormone in the mother
At what stage can movements of the fetal chest be detected?
As early as 10 weeks
What is the kPa in the umbilical artery of the fetus?
4.53kPa (vs 13.3kPa in the mother)
In the healthy newborn, what factors stimulate respiration?
Skin stimulation
Skin cooling (in the absence of core temperature changes)
What mechanism is responsible for airway liquid clearance after birth?
Hydrostatic pressures generated by inspiration
Spontaneous inspiratory movements by the newborn baby generate a transepithelial pressure gradient between the interstitial tissue and the airway lumen, and as a result the lung fluid is drawn from the proximal airways into the distal one where is is cleared across the distal airwavey wall into the surrounding interstitial tissue space
How long does it take for complete airway liquid clearance?
Typically achieved within the first 4 hours
What is the rate of gasping?
Approx. 12/minute
Shuddering whole body gasps
What is the first sign of effective oxygen delivery to the heart?
A rise in heart rate
What are the recommended initial oxygen concentrations to be delivered?
> 32 weeks - Air
28+0 - 32+0 - 21-30%
<28 weeks - 30%
What are the acceptable right arm (pre-ductal) saturations?
2 minutes: 65%
5 minutes: 85%
10 minutes: 90%
Which factors should be included in your assessment of the patient?
Colour
Tone
Breathing/ respiratory effort
HR
What are the options for cord clamping?
- At least 60 seconds of DCC unless it would prevent immediate resuscitation measures that are deemed necessary
- If resuscitation is required, and 60s of DCC is not practical, then cord milking is an option in babies >28 weeks gestation (cord milking should not be practised in babies earlier than 28 weeks gestation)
- Immediate cord clamping may be necessary
What pressures should be used for inflation and ventilation breaths?
> 32 weeks: 30cm H2O
<32 weeks: 25cm H2O
Which group are laryngeal masks useful in?
> 2000g or over gestational age of 34 weeks
How is an oropharyngeal mask measured?
Flange in the middle of the lips and the other end should reach the angle of the jaw
How should the deep trachea be suctioned?
Using an ETT attached to a meconium aspirator
What is the rate of chest compressions?
You should be delivering 3 compressions to one ventilation breath at a rate of about 15 cycles every 30 seconds
Where should chest compressions be delivered?
Over the lower third of the sternum
How deep should chest compressions be delivered?
A a third of the depth of the chest
How frequently should the HR be rechecked during chest compressions?
Every 30 seconds
What is the preferred route to administer resuscitation drugs?
UVC
Secondly an IO could be used
What is the only resuscitation drug that can be given via a tracheal tube?
Adrenaline although this route is less effective
How frequently is adrenaline administered?
Every 3-5 minutes
