NRP Flashcards
What are the 4 Pre- birth questions to ask for every laboring patient?
Gestational age?
•What’s the amniotic fluid status? (intact or ruptured; clear/mec & how long).
• Are there any risk factors?
• What’s our plan for the umbilical cord? (always plan for 30sec. minimum delayed cord clamping)
What are the 3 post-birth evaluation questions?
Does baby look term?
How is the tone?
Is baby breathing/crying?
When do we start PPV?
• HR <100bpm
• No Respiratory effort
What should our oxygen concentration be set to for PPV for term babies?
21%
What should our oxygen concentration be set to for premature PPV?
30%
When do we reassess HR?
After 30 sec. of effective PPV
What do we do if PPV is established but there’s no chest rise or increase in HR?
MRSOPA
What’s MRSOPA
• Mask adjustment & Reposition head/neck
• Suction & Open the mouth
• Pressure increase
• Alternate airway
When do we need to Intubate?
• HR <100bpm and no increase with PPV via face mask
• Prior to chest compressions
What do we do prior to chest compressions?
LMA or ETT
What’s a LMA
Laryngeal mask airway
Why is LMA the first resort
less invasive and easier to insert
What is the second line of intubation?
ETT
How long do the docs get to attempt intubation before having to reset?
30 seconds
If the HR is decreasing after intubation, what do we check for?
DOPE
Displaced tube
Obstructed tube?
Pneumothorax
Equipment issue
When do we start compressions?
HR <60 after 30 sec. of effective PPV
What should our oxygen concentration be set to during compressions?
100% BEFORE starting compressions
What is our compressions rate?
90 compressions : 30 breaths per min.
~one-and-two=and-three-and-breathe~
How long do we do compressions before assessing a HR?
60 seconds
What do we do if the HR is still not increasing after 60 sec. compressions?
CARDIO
Chest moving?
Airway secure?
Rate correct?
Depth correct?
Inspired O2 @ 100%?
When do we give Epinephrine?
• HR <60 after 30 sec. effective PPV and 60 sec. compressions with 100% 02
What are the doses of epinephrine?
•ETT: 0.1mg/kg = 1ml/kg given ONCE, followed by a few puffs of PPV to flush through
•IV/Uvc/IO: 0.2mg/kg = 0.2ml/kg, given q3-5min PRN followed by 3ml NS flush
What do we do if HR is not increasing after epinephrine?
Consider volume expanders if signs of shock or history of blood loss
What are volume expanders
NS or PRBC
What is our dose and how do we administer volume expanders?
10ml/kg over 5-10 minutes
When do we start CPAP?
HR >100bpm and infant breathing spontaneously with signs of respiratory distress
Or
Oxygen saturation is not within target range
When would we use supplemental Oxygen?
HR > 100
No resp distress
O2 sats not within target range
A term baby with HR < 100 or no respiratory effort should receive:
PPV @ 21%
A preterm baby with HR < 100 or no respiratory effort should receive:
PPV @ 30%
A baby with a HR > 100 showing signs of nasal flaring and grunting should receive:
CPAP started at 21%
A baby with a HR > 100 and no signs of resp distress with low target oxygen should receive
Free flow O2
