NRP

Question 1

What are the 4 Pre- birth questions to ask for every laboring patient?

Answer 1

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)

Question 2

What are the 3 post-birth evaluation questions?

Answer 2

Does baby look term?
How is the tone?
Is baby breathing/crying?

Question 3

When do we start PPV?

Answer 3

• HR <100bpm
• No Respiratory effort

Question 4

What should our oxygen concentration be set to for PPV for term babies?

Answer 4

21%

Question 5

What should our oxygen concentration be set to for premature PPV?

Answer 5

30%

Question 6

When do we reassess HR?

Answer 6

After 30 sec. of effective PPV

Question 7

What do we do if PPV is established but there’s no chest rise or increase in HR?

Answer 7

MRSOPA

Question 8

What’s MRSOPA

Answer 8

• Mask adjustment & Reposition head/neck
• Suction & Open the mouth
• Pressure increase
• Alternate airway

Question 9

When do we need to Intubate?

Answer 9

• HR <100bpm and no increase with PPV via face mask
• Prior to chest compressions

Question 10

What do we do prior to chest compressions?

Answer 10

LMA or ETT

Question 11

What’s a LMA

Answer 11

Laryngeal mask airway

Question 12

Why is LMA the first resort

Answer 12

less invasive and easier to insert

Question 13

What is the second line of intubation?

Answer 13

ETT

Question 14

How long do the docs get to attempt intubation before having to reset?

Answer 14

30 seconds

Question 15

If the HR is decreasing after intubation, what do we check for?

Answer 15

DOPE

Displaced tube
Obstructed tube?
Pneumothorax
Equipment issue

Question 16

When do we start compressions?

Answer 16

HR <60 after 30 sec. of effective PPV

Question 17

What should our oxygen concentration be set to during compressions?

Answer 17

100% BEFORE starting compressions

Question 18

What is our compressions rate?

Answer 18

90 compressions : 30 breaths per min.

~one-and-two=and-three-and-breathe~

Question 19

How long do we do compressions before assessing a HR?

Answer 19

60 seconds

Question 20

What do we do if the HR is still not increasing after 60 sec. compressions?

Answer 20

CARDIO

Chest moving?
Airway secure?
Rate correct?
Depth correct?
Inspired O2 @ 100%?

Question 21

When do we give Epinephrine?

Answer 21

• HR <60 after 30 sec. effective PPV and 60 sec. compressions with 100% 02

Question 22

What are the doses of epinephrine?

Answer 22

•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

Question 23

What do we do if HR is not increasing after epinephrine?

Answer 23

Consider volume expanders if signs of shock or history of blood loss

Question 24

What are volume expanders

Answer 24

NS or PRBC

Question 25

What is our dose and how do we administer volume expanders?

Answer 25

10ml/kg over 5-10 minutes

Question 26

When do we start CPAP?

Answer 26

HR >100bpm and infant breathing spontaneously with signs of respiratory distress Or Oxygen saturation is not within target range

Question 27

When would we use supplemental Oxygen?

Answer 27

HR > 100 No resp distress O2 sats not within target range

Question 28

A term baby with HR < 100 or no respiratory effort should receive:

Answer 28

PPV @ 21%

Question 29

A preterm baby with HR < 100 or no respiratory effort should receive:

Answer 29

PPV @ 30%

Question 30

A baby with a HR > 100 showing signs of nasal flaring and grunting should receive:

Answer 30

CPAP started at 21%

Question 31

A baby with a HR > 100 and no signs of resp distress with low target oxygen should receive

Answer 31

Free flow O2