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NRP Flashcards

1
Q

What is the most common cause of need to resuscitate a newborn?

A

Respiratory, as in general their heart is normal

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2
Q

Causes of respiratory insuficiency in newborn

A
  1. Pre-birth: placental insufficiency- no O2 or removal of O2, leading to metabolic acidosis- decreased activity, loss of HR variability and HR deceleratiosn– apnea , bradycardia.
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3
Q

3 questions to answer at birth

A
  1. At term?
  2. TOne?
  3. Breathing or crying?
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4
Q

How is CO2 removed in fetus?

A

CO2 from baby goes through placenta and then is removed by mom lungs.

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5
Q

Fetal lungs are expanded in utero but the alveoli is full with fluid.

A

TRUE

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6
Q

Fetal circulation

A

O2 from placenta through umbilical vein.
Umbilical vein bypasses the livery through the DUCTUS VENOSUS and joins the INFERIOR VENA CAVA
INFERIOR VENA CAVA –> R heart.

Because the pulmonary vessels are constricted , only a small fraction of blood entering the heart travels to the fetal lungs. Most blood bypassess lungs crossing to the left side of the heart through the PATENT FORAMEN OVALE, OR flowing from the pulmonary artery directly into the aorta through the DUCTUS ARTERIOSUS

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7
Q

3 changes from fetal to neonatal circulation

A
  1. Baby breaths
    Umbilical cord is clamped, separating the placenta from the baby — newborn uses lungs now for gas exhange
  2. Fluid in the alveoli is absorbed- O2 and CO2.
  3. Air in the alveoli causes blood vessels in the lung to dilate so that blood can reach the alveoli where o2 is. - ductus arteriosus gradually constrict.
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8
Q

It may take up to 10 minutes for a normal term newborn to achieve SaO2 > 90%.

A

True

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9
Q

When does closure of PDA occurs completely?

A

In full-term infants, postnatal closure of the ductus is effected in two phases:
smooth muscle constriction produces “functional” closure of the lumen of the ductus within 18 to 24 hours after birth; and “anatomical” occlusion of the lumen occurs over the next few days or weeks.

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10
Q

Clinical findings of abnormal transition to neonatal respiration

A

redistribution of blood0 and if persist can occur:

  • Irregular breathing, apnea, tachypnea
  • bradycardia or tachycardia
  • decreased muscle tone
  • decreased O2 saturation
  • Decreased BP
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11
Q

Pre-resuscitation team briefing

A

Assess perinatal risk factors
Identify a leader
Delegate tasks
Identify who will document events as they occur
Determine what supplies and equipment will be needed
Identify how to call for additional help

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12
Q

Before every birth

4 prebirth questions

A
  1. What is the expected gestational age?
  2. Is the amniotic fluid clear?
  3. How many babies are expected?
  4. Are there any additional risk factors?
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13
Q

What personal should be present at delivery

A

Any birth: at least 1 qualified individual-in initial steps of newborn care and PPV

If risk factors: at least 2 qualified

For a complex resuscitation at least 4 persons.

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14
Q

Fetal HR categories

A

I : normal tracing predictive of normal fetal acid-base status at the time of observation, and routine followup is indicated

II: Considered indeterminate tracing. further eval, continued surveillance and re-evaluation are indicated

III. Abnormal tracing, predictive of abnormal fetal acid-base status at the time of observation.r requires prompt eval and intervention

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15
Q

Critical performance steps

A

Ask 4 pre-birth questions
Assemble team based on perinatal RF
Perform pre-resuscitation briefing
perform equipment check by critical steps

Warm
Clear airway
Auscultate
Ventilate
Oxygenate
Intubate
Medicate
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16
Q

What is needed for warming

A

Preheated warmer
warm towels or blankets
T sensor or sensor cover for prolonged resuscitation
Hat
Plastic bag or wrap ( < 32 weeks gestation)
Thermal mattress ( ( < 32 weeks gestation)

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17
Q

What is needed for clearing airway

A

Bulb syringe
10F or 12 F suction catheter attached to wall suction, set at 80-100 mmHg.
Meconium aspirator

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18
Q

Potential benefits of delayed cord clamp in preterm

A

decreased mortality
higher BP and blood volume
less need for blood transfusion after birth
fewer brain hemorrhages

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19
Q

What is delayed clamping

A

should be delayed 30 - 60 seconds for most vigorous term and preterm newborns.

Very preterm should be wrapped in warm blanket between birth and umbilical cord clamping.

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20
Q

In what circumstances umbilical cord should be clamped immediately after birth

A

when integrity of placenta is not adequate

placental abruption
bleeding of placenta previa
bleeding vasa previa
cord avulsion

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21
Q

There is no evidence for delayed clamping in multiple gestations

A

TRUE,

Other scenarios include IUGR

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22
Q

If baby is preterm right after birth, next step

A

bring to radiant warmer to perform initial steps.

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23
Q

Initial steps of newborn care

A

WARM
Position head and neck-airway “ sniffing position”
Clear secretions if needed - MOUTH BEFORE NOSE
Dry
Stimulate

Clamping should be completed 30 seconds after birth

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24
Q

If term, tone, crying is YES, next step?

A

clamping should occur within 30 seconds
bring to mom and initial steps can be completed over mom.
Cover with blanket, dry and stimulate.
Secretions can be removed with cloth.

Bulb syringe may be used for meconium stained fluid, secretions that obstruct breathing, difficulty clearing secretions

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25
Q

When do you use Bulb syringe for clearing airway?

A

IN NONVIGOROUS, PRETERM

meconium stained fluid,
secretions that obstruct breathing,
difficulty clearing secretions

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26
Q

What is the T that should be maintained in newborn while resuscitation?

A

36.5- 37.5

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27
Q

To help maintain sniffing position what can you do?

A

place a small . rolled towl under the babys shoulders.

May be useful if has a large occiput from molding , edema, prematurity.

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28
Q

Order of suctioning airway

A

mouth before nose

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29
Q

Why should suctioning be gentle, not vigorous??

A

IF stimulation posterior pharynx– vagal response— bradycardia or apnea

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30
Q

Drying in < 32 weeks

A

not with towels– they should be covered in polyethylene plastic

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31
Q

When do you use polyethylene plastic

A

in preterms < 32 weeks

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32
Q

Baby with apnea, gasping or HR < 100. Next step?

A

PPV!!!

This is before any CPR. It is highly likely that is respiratory failure

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33
Q

HR assessment, how and where?

A

Auscultation of left side of the chest. – while listening you can tap on the table for the rest of the team to listen

COUNT THE NUMBER OF BEATS IN 6 SECONDS AND MULTIPLY BY 10

Pulsations in the umbilical cord are less accurate and may underestimate the true heart rate.

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34
Q

If you cant identify HR with auscultation, next step

A

ask team member to connect pulse oximetry sensor or electronic cardiac monitor leads.

pulseox may not work if poor perfusion

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35
Q

if baby breathing, HR at least 100 and persistent cyanosis

A

is normal to have acrocyanosis
but if persistent connect pulseox

O2 is only administered if SaO2 is below target range

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36
Q

Indications for pulse oximeter

A
  1. resuscitation is anticipated
  2. confirm your perception of persistent central cyanosis
  3. When supplemental oxygen is administered
  4. When PPV is required.
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37
Q

Uterine blood O2 sat

A

60%

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38
Q

SaO2 variability from birth

A

Uterine blood SaO2 is 60%

After birth it starts to increase, around min 6 reached 90% and has a slow increase. About min 15 is ~ 95%

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39
Q

Oximeter placement in newborn

A

right hand hypothenar eminence

OR
Wrist

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40
Q

Why attaching the pulseox to right hand ?

A

The artery supply to the right hand also attaches to the aorta before the Ductus arteriosus.
- PREDUCTAL SATURATION

The supply for left arm is less predictable

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41
Q

Why preductal saturation?

A

PREDUCTAL SATURATION - blood that is irrigating the heart and brain.

The legs and left arm receive blood from the aorta after it has mixed with poorly oxygenated venous blood shunted from the right side of the heart through the ductus arteriosis (post-ductal)

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42
Q

Target preductal SpO2

A 
1min-60%-65%
2min 65-70%
3 min 70-75%
4 min 75%-80%
5 min 80-85%
10 min 85%-90%
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43
Q

Free-flow O2 devices

A

Oxygen tubing
Oxygen mask
Flow-inflating bag and mask
Open reservoir( “tail”), on a self-inflating bag.

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44
Q

What is CPAP

A

method of respiratory support that uses a continuous low gas pressure to keep spontaneously breathing baby’s lung open.

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45
Q

When does CPAP should be considered?

A

Baby is breathing and HR is at least 100 bpm

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46
Q

NRP does NOT recommend endotracheal suction for non-vigorous babies delivered through meconium stained fluid.

A

TRUE, just do the regular algorithm

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47
Q

Clamping umbilical cord should be delayed for at least 30-60 seconds for most vigorous newborns not requiring resuscitation

A

True

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48
Q

Free flow supplemental O2 is not effective if baby is not breathing

A

True

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49
Q

Free flow supplemental O2 cannot be given by mask

A

True has to be the tail on some inflating bags.

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50
Q

NRP key behavioral skills

A 
know your environment
use available information
anticipate and plan
clearly identify a team leader
communicate efficiently
delegate workload optimally 
allocate attention wisely
Use available resources
Call for additional help when needed 
Maintain professional behavior.
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51
Q

Definition term pregnancy

A

Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Postterm: 42 0/7 weeks and beyond

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52
Q

PPV is placed, pulse Ox and ECG. HR <100. Next step

A

Check chest movement
Ventilation corrective steps:
- Reapply the mask to the face and reposition face and neck

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53
Q

Peak inspiratory pressure (PIP)

A

the highest pressure administered with each breath

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54
Q

Positive end-expiratory pressure (PEEP)

A

The gas pressure maintained in the lungs between breaths when the baby is receiving assisted breaths

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55
Q

Continuous positive airway pressure CPAP

A

the gas pressure maintained in the lungs between breath when a baby is spontaneously breathing

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56
Q

IT- Inspiratory time

A

the timeduration ( sec) of the inspiratory phase of each positive pressure breath

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57
Q

3 types of devices for ventilation

A
  1. self-inflating bag- fills spontaneously with gas
  2. flow inflating bag ( anesthesia bag, fills when gas from a compressed source flows into it)
  3. T piece resuscitator
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58
Q

Indications for PPV

A

Apnea OR
Gasping OR
HR<100 OR
O2 below the target preductal Sao2 despite free-flow O2

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59
Q

When should PPV be started when indicated

A

within 1 min of birth

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60
Q

What concentration of O2 should be given to start PPV?

A

> = 35 weeks: 21%
<35 weeks 21-30%

Set the flowmeter to 10 L/min

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61
Q

What ventilation rate should be used during PPV?

A

40-60 breaths per min

” BREATH, TWO , THREE”
SQUEEZE THE BAG WHEN YOU SAY BREATH
OR CLOSE THE T PIECE RESUSCITATOR WHEN BREATH

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62
Q

How much pressure should be used for ppv

A

PIP: 20-25 cm H20

PEEP 5 cm H20

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63
Q

How do you evaluate the baby’s response to PPV

A

The single most important indicator is rise in HR

First HR assessment at 15 seconds of PPV

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64
Q

If PPV was started because of HR< 100

A

HR should start to increase within 15 seconds of PPV

If not assess ventilation

If increases, reasses in 15 seconds.

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65
Q

Ventilation corrective steps

A

MR SOPA
Mask adjustment- consider 2 hand teachnique
Reposition airway
Try PPV and reassess chest mov

Suction mouth and nose
Open mouth and lift jaw forward
Try PPV and reassess chest mov

Pressure increase - increase pressure in 5-10 cm H2O increments , max 40cm H20

Try pPV andreasses chest mov

Alternative airway- place endotracheal tube or laryingeal mask.

66
Q

Ventilation corrective steps

A

MR SOPA
Mask adjustment- consider 2 hand teachnique
Reposition airway-place head neutral or slightly extended
Try PPV and reassess chest mov

Suction mouth and nose
Open mouth and lift jaw forward
Try PPV and reassess chest mov

Pressure increase - increase pressure in 5-10 cm H2O increments , max 40cm H20

Try pPV andreasses chest mov

Alternative airway- place endotracheal tube or laryingeal mask.

67
Q

CPAP can be administered with a T piece resuscitator or a flow inflating mask BUT NOT THROUGH A SELF INFLATING MASK.

A

T

68
Q

CPAP pressure

A

start with 5

no use more than 8

69
Q

When do you insert an orogastric tube?

A

CPAP or PPV with mask that is required for may minutes. to avoid gas entering to stomach

leave the orogastric tube uncapped.

70
Q

Equipment needed for orogastric tube

A

8F feeding tube
Large syringe
Tape

-

71
Q

How much do you insert the orogastric tube

A

distance from the bridge of the nose to the earlobe and from the earlobe to a point halfway between the xiphoid process and the umbilicus.

note the cm mark at this place on the tube
enter the tube through mouth adn attach a syringe and remove gastric contents
remove syringe leave end of tube open
tape the tube to the cheek of pt

72
Q

CO2 detector color codes

A

blue/purple: not ventilating the longs or low cardiac output

yellow ventilating lungs .

73
Q

Advantages /disadvantages of self inflating mask

A

Advantages :

  • easier to use
  • little set up time

Disdvantages:

  • because it fully reinflates even without a seal is difficult to know if there is a leak.
  • Inspiratory time difficult to control.
  • NOT FOR CPAP
74
Q

Advantages /disadvantages of flow inflating mask

A

Advantages :

  • know if there is a leak- mag will deflate
  • PEEP/CPAP
  • Inspiratory time can be increased by squeezing the mask for a longer period of time

Disadvantages:

  • difficult set up
  • more experience for using it effective
  • requires a gas source and adjustments to find correct balance between outflow and inflow.
75
Q

Advantages /disadvantages of T piece resuscitator

A

Advantages :

  • provides more consisten pressure with each breath than the other methods.
  • users may not become fatigued of squeezing bag
  • inspiratory time can be increased by occluding the hole on the T piece cap for a longer period ot time.

Disadvantages:

  • difficult set up
  • more experience for using it effective
76
Q

Free flow oxygen cannot be given reliably via the mask of a self inflating mask. It has to be through the tail of an open reservoir.

A

TRUE pg 92.

But free flow O2 can be given via the mask of a flow inflating bag or piece resuscitator..

If flow inflating bag the bag should not inflate- it would indicate that the mask is tight against the face and ppv IS being used

77
Q

There is no difference between resuscitating with 21% O2 or 100%

A

True,

21% is at least as effective as 100%

78
Q

What happen to preterm babies if exposed briefly to high concentrations of O2?

A

changes in cerebral blood flow and higher risk of chronic lung disease
pulmonary vascular resistance decreases with 21%. There was an initial concern that high concentrations would develop pulmonary HTN

79
Q

A trial of PPV may be considered if the baby is breathing and HR >=100, but SaO2 cannot be maintained despite free flow O2 or CPAP

A

t

80
Q

How many qualfied team memebers are needed for PPV

A

2, If alone call for immediate assistance

81
Q

The most important indicator of successful PPV

A

increased HR

82
Q

If the heart is not increasing within 15 seconds of PPV

A

check chest movement

83
Q

If the heart is not increasing within 15 seconds of PPV and no chest movement

A

ventilation corrective steps

84
Q

After PPV is HR is at least 100, reduce the rate and pressure of PPV while observing for effective spontaneous respirations and stimulating the baby

A

if discontinued, use free flow O2 or CPAP to maintain O2 saturation within target

85
Q

pop off valve pressure in self inflating bag

A

30-40cm H20

86
Q

Laryngeal mask vs. endotracheal tube

A

small mask attached to an airway tube that is inserted into the mouth and advanced until the mask covers the glottis.

endotracheal tube is advanced through the glottis, while the laryngeal mask is a supraglottic airway device.

87
Q

When do you use laryngeal mask

A

when attempts at face mask ventilation and intubation are unsuccessful.

Placement of laryngeal mask doesn’t require visualization of the larynx or the use of an instrument for insertion.

88
Q

Use of laryngeal mask in preterm babies is limited

A

True, because the smallest available size may be too large for smaller newborns.

89
Q

When should an alternative airway be considered (6)

A

Failure of PPV with face
If PPV last more than a few minutes,an endotracheal tube or a laryngeal mask may improve efficacy an ease

Also, if:

  • compressions are necessary
  • stabilization of newborn with suspected diaphragmatic hernia
  • for surfactant administration
  • direct tracheal suction if airway is obstructed with thick secretions.
90
Q

Materials for endotracheal intubation

A
  1. Laryngoscope handle with an extra set of batteries and extrabulbs
  2. Layngoscope blades:
    No. 00( optional for very preterm newborn)
    No.0 ( preterm)
    No.1 ( term newborn)
    MILLER BLADE PREFERRED (STRAIGHT) THAN THE CURVED MACINTOSH.

3.Endotracheal tubes internal diameters 2.5,3,3.5

  1. Stylet( optional ) that fits into the tracheal tube
  2. co2 monitor detector
  3. Suction setup with suctioning catheters
    8F
    pharynx size 10-12F
    5F,6F, for suctioning endotracheal tubes
  4. Wterproof adhesive tape, or the tube securing device
  5. Measuring tape and /or endotracheal tube insertion depth table
  6. Scissors
  7. Meconium aspirator
  8. Stethoscope ( neonatal head)
  9. PPV device ( bag or T piece resuscitator) and tubing for blended air an oxygen
  10. Pulse oximeter, sensor and cover
  11. Laryngeal mask ( size 2) or other supraglottic device, and a 5 ml syringe.
91
Q

Layngoscope blades , sizes and types

A

No. 00( optional for very preterm newborn)
No.0 ( preterm)
No.1 ( term newborn)
MILLER BLADE PREFERRED (STRAIGHT) THAN THE CURVED MACINTOSH.

92
Q

Endotracheal tubes internal diameters

A

2.5,3,3.5

93
Q

suctioning catheters sizes and location

A

8F
pharynx size 10-12F
5F,6F, for suctioning endotracheal tubes

94
Q

Tapered and cuffed tubes are NOT recommended for neonatal resuscitation

A

True

95
Q

Endotracheal tube size

A

< 28 weeks(<1000g) - 2.5 mmID
28-34 (1,000-2,000g)- 3 mmID
>34 (> 2,000g)- 3.5 mmID

96
Q

Why do you use stylet in the endotracheal tube?

A

To provide additional rigidity and curvature
Use is OPTIONAL

Make sure that the tip is not protruding ( may cause damage to tissues)

97
Q

Suction catheter size based on ET tube size

A

2.5 - syringe is 5F-6F
3-syringe is 6F-8F
3.5-syringe is 8F

98
Q

The vocal cord guide on an endotracheal tube DOES NOT reliable predict the correct insertion depth

A

T

99
Q

In which hand do you hold the laryngoscope

A

left

100
Q

Where do you insert the laryngoscope blade?

A

RIGHT side of the babys mouth and slide blade over the tongue toward the midline.

101
Q

How do you insert the ET tube once you are positioned?

A

insert the tube into the right side of the babys mouth with the concave curve in the horizontal plane.

DO NOT INSERT THE TUBE THROUGH THE LARYNGOSCOPE OPEN CHANNEL - obstruct your view from the vocal cords.

102
Q

time allowed for intubation attempt

A

30 seconds

103
Q

Describe how you intubate.

A

pg 125-131

104
Q

If while intubating the baby’s VS worsen, what do you do

A

stop , resume PPV with mask and retry again

105
Q

Confirmation that endotracheal tube is in the trachea

A

THE MAIN: detecting exhaled CO2 and rapidly rising heart rate

others:
-audible breath sounds ( best place near the axilla), check also stomach area to see that no air is there.
-symmetrical chest mov
-little or no air leak from the mouth during PPV
-

106
Q

2 types of CO2 detectors

A

Colorimetric devices

Capnography

107
Q

Can the tube be in trachea even though CO2 is NOT detected?

A

Yes, tube may be obstructed with secretions, lack of adequate ventilating pressure, pneumothroax or babies with poor cardiac function.

108
Q

Causes of False positive Colometric CO2 detection- tube is not in the trachea but color changes .

A
  • defective device- changed color in package before use.

- Epinephrine contamination

109
Q

Causes of False negative Colometric CO2 detection-

A
  • inadequate ventilating pressure
  • collapsed lungs
  • bilateral pneumothoraces
  • low heart rate
  • low cardiac output
110
Q

If suspect that the tube is not in the trachea?

A 
remove tube
resume ventilation with a face mask
ensure that equipment is properly prepared 
position baby
repeat intubation
  • May be in esophagus.
111
Q

How deep should the tube be inserted within the trachea

A

1-2cm below the vocal corss.

Insertion depth:

  1. NTL: nose septum to ear tragus . Estimated depth is NTL+1 cm
  2. Gestation age
112
Q

Technique for securing the ET tube

A

cut the water resistant tape like pants.
Place the uncut section of tape on the baby’s cheek so that the beginning of the split is close to the corner of the baby’s mouth.

Place upper leg across the babys upper lip

wrap the lower leg around the tube.

113
Q

Always after confirming that the tube is placed correctly, order an Xray.

A

True

The tup of the tube should appear in the midtrachea adjacent to the first or second THORACIC vertebra., and above the carina.

114
Q

suction source for ET intubation is set up at

A

80-100mmHg

115
Q

Sudden deterioration after intubation

A

DOPE

Displaced endotracheal tube
Obstructed endotracheal tube
Pneumothorax
Equipment failure

116
Q

What if you cannot ventilate and intubate?

A

laryngeal mask attached to PPV device and CO2 detector, and begin PPV

117
Q

How to use laryngeal mask

A

enter the tube supraglottic- tip of esophagus
inflate cuff
It has a 15 mm connector- PPV

mask covers the glottislike a cap and the inflated cuff creates a seal against the hypopharynx. Has an aperture bar that prevent the epiglottis from being drawn into the airway.

118
Q

When do you use a laryngeal mask

A

When you cant ventilate or intubate

Also,
1.Newborns with congenital abnormalities involving the mouth, lip, tongue , palate, neck, where achieving a good seal with a face mask is difficult and analyzing the larynx with a laryngoscope is difficult or unfeasible.

  1. Newborns with smaller mandible or large tongue, where face mask ventilation and intubation are unsuccessful. -Robin sequence or Trisomy 21
  2. When PPV provided with face mask is ineffective and failed intubation
119
Q

Limitations laryngeal mask

A
  • no suctioning
  • if need of high ventilation pressures, air may leak through the seal.
  • few reports of laryngeal mask plus compressions.
  • insufficient evidence to medicate through laryngeal masl
  • cannot be used in very small newborns.
120
Q

Placement of laryngeal

A

Before inserting the laryngeal mask make sure you attach a syringe to the inflation por and completely deflate the cuff. lubricate the mask.

left thumb to open airway,laryngeal mask on the right
lead the tip of the mask agains the hard palate, advance until resistance

-inflate cuff- 5mL
Attach to PPV and CO2 detector.
Auscultate
- optional: attach a gastric drain

121
Q

Laryngeal mask can attach to CPAP or PPV

A

True

122
Q

Complications Laryngeal mask

A

soft tissue trauma
laryngospasm
gastric distention from air leaking

if prolonged use
oropharyngeal nerve damage or tongue swelling un adults. not in newborns.

123
Q

how many providers are needed if need to perform alternative airway

A

3-4

124
Q

ET intubation is required before chest compressions.

A

to ensure maximum ventilation efficacy both before and after chest compressions begin.

125
Q

Insertion of endotracheal tube or laryngeal mask should be considered if.

A

PPV with a face mask does not result in clinical improvement

If PPV lasts more than a few minutes

126
Q

Insertion of endotracheal tube is strongly recommended

A

If chest compressions are necessary
In special circumstances:
1. Stabilization of newborn with suspected diaphgramatic hernia
2. surfactant administration
3. Direct tracheal suction if the airway is obstructed by thick secretions

127
Q

intubation procedure should be done within 30 seconds

A

true

128
Q

Avoid repeated unsuccessful attempts at endotracheal intubation. A karyngeal mask provide a rescue airway when PPV with face mask fails.

A

true

129
Q

If in glottis in view, but the vocal cords are closed WAIT until they are open to insert

A

yes

130
Q

Indications for chest compressions

A
  1. when HR <60 after at least 30 sec of PPV with chest expansion
  2. In most cases, you should have given at least 30 seconds of ventilation through a properly inserted endotracheal tube or laryngeal mask.
131
Q

Where should be placed the provider making chest compressions?

A

at the head of the table

This is to provide space for umbilical venous catheter insertion and because this position results in less fatigue for the compressor.

132
Q

Where should be compressions started

A

below the nipple line, in the lower third of sternum

133
Q

Compression rate

A

3:1 during EVERY 2 SECONDS

90 compressions per minute

One and Two and three and Breath, and One and two, and three and breath

-and is for chest recoil.

134
Q

What O2 concentration should be given with PPV during chest compressions

A

100%,

once the HR is more than 60 adjust to meet the target Sao2

135
Q

When do you check the HR after starting compressions

A

within 60 seconds

136
Q

How to assess the baby’s HR response during compressions?

A

ECG

137
Q

When do you stop chest compressions

A

when HR is 60 bpm or higher.

return to giving PPV at the faster rate of 40-60 breaths per minute

138
Q

If HR remains < 60 despite 60 seconds of good quality compressions and effective ventilation

A

Epinephrine

139
Q

Why 3:1 ratio for compressions?

A

Neonatal animal studies have demonstrated that 3:1 ratio shortens the time to return of spontaneous circulation

140
Q

Reasons to why CO2 detector did not change color even though the endotracheal tube was correctly placed?

A

baby has low HR or poor cardiac function

141
Q

If HR < 60 bpm and pulse oximeter stops working?

A

Continue ventilation with 100% oxygen until HR is at least 60 and pulse ox has a reliable signal.

142
Q

When do you reasses HR once compressions have started?

A

60 sec after

143
Q

When the step of epinephrine adminisitration occurs is because of

A

there is severely decreased coronary artery blood flow.

Epinephrine improves coronary artery perfusion and O2 delivery

144
Q

Epinephrine MOA

A

Vasoconstrictor of peripheral vessels

Increased contractility and rate of heart

145
Q

When is epinephrine indicated

A

When HR remains < 60 after:
- at least 30 seconds of PPV that inflates the lungs
AND
-Another 60 seconds of chest compressions coordinated with PPV using 100%.

EPI IS NOT INDICATED BEFORE YOU HAVE ESTABLISHED EFFECTIVE VENTILATION

146
Q

Epi concentration

A

1:10,000 preparation ( 0.1mg/mL)

147
Q

Epi dose

A

IV/IO: 0.1-0.3 mL/kg which equal to 0.01-0.03 mg/kg
follow with 0.5 to 1 mL flush

Endotracheal 0.5 to 0.1mL/kg – 0.05-0.1 mg/kg.

148
Q

After Epi, how much do you wait to assess HR

A

1min

149
Q

After Epi you should continue PPV with 100% O2 and chest compressions. The heart rate should increase to at least 60 bpm WITHIN 1 MIN of epinephrine administration

A

True

150
Q

When should you include volume expander?

A 
acute fetal maternal hemorrhage
bleeding vasa previa
extensive vaginal bleeding
placental laceration 
fetal trauma
umbilical cord prolapse
tight nuchal cord
blood loss from umbilical cord
151
Q

The Dose of initial bolus of NS

A

10 mL/kg over 5 -10 min may repeat same dose

preparation: 30-60mL syringe

152
Q

If there is confirmed absence of HR after 10 minutes of resuscitation it is reasonable to stop

A

True, but the decision should be individualized

153
Q

What does 1:10,000 concentration of epi means

A

1 gram of epi dissolved in 10,000 mL of fluid.
Equivalent to 0.1 mg/mL

The dose is 0.1-0.3mL/kg

154
Q

why is preferred to give epi via IV/IO than endotracheal

A

the process of absorption by the lungs makes the response time slower and unpredictable.

higher doses are often needed in endotracheal administration

155
Q

After intraosseus needle insertion , is it necessary to aspirate the syringe before infusing fluid?

A

NO

156
Q

Epinephrine should be administered as quickly as possible

A

TRUE

157
Q

Persistent Pulmonary Hypertension of the newborn PPHN

A

IN >=34 gestational age
May require supplemental O2and in many cases PPV
Severe PPHN require ECMO

158
Q

Should Sodium bicarbonate be given to babies with metabolic acidosis?

A

NO

No evidence and potential SE:
acidosis may increase because CO2 is formed.
increased risk . of intraventricular hemorrhage in preterm newborns.

159
Q

Babies at risk of pulmonary HTN should NOT receive routinely sufficient supplemental oxygen to achieve a target saturation of 100%

A

true

160
Q

Why do preterms have a high risk of complications?

A
  1. Thin skin, decreased subcutaneous fat, large surface area and limited response to cold lead to rapid heat loss
  2. Decreased efficiency of spontaneous breathing effors: weak chest muscles and flexible ribs
  3. Immature lungs that lack surfactant are more difficult to ventilate and greater risk of injury from PPV
  4. Immature tissues more likely to be damaged byO2
  5. Smaller blood volume increases the risk of hypovolemia if there is blood loss
  6. Limited metabolic reserves and immature compensatory mechanisms increase the risk of hypoglycemia

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