NRP Advanced (Chapters 5-11)

Question 1

What are the indications for endotracheal intubation?

Answer 1

if baby’s heart rate is persistently under 100bpm and not increasing with PPV

Question 2

What would ideally happen first before chest compressions begin?

Answer 2

Endotracheal Intubation

Question 3

What can be used in lieu of endotracheal intubation and in what specific circumstance?

Answer 3

If endotrachael intubation is not successful or feasible and baby weighs at least 1500-2000g (3-4ishlbs)

Question 4

Other indications for endotracheal intubation?

Answer 4

1) Direct suction of thick obstructive secretions
2) Surfactant administration
3) A newborn with a suspected diaphragmatic hernia
4) in the case where PPV is prolonged in order to improve efficacy + ease of assisted ventilation

Question 5

What are the indications for chest compressions?

Answer 5

• persistent bpm under 60 with ventilation that has moved the chest for at least 30 seconds preferably with an alternative airway

Question 6

What is the preferred route of epinephrine administration?

Answer 6

intravenous into the umbilical vein

Question 7

Why is the intravenous route preferred over the endotracheal route for epinephrine administration?

Answer 7

studies have shown that the absorption of epinephrine via the endotracheal route is unreliable

Question 8

What is the epinephrine concentration used for newborn resus?

Answer 8

0.1mg/ml (or 1mg/10ml)

Question 9

What is the recommended initial dose of epinephrine used for newborn resus?

Answer 9

0.02mg/mL (or 0.2g/10mL)

Question 10

After epinephrine admin when do you reassess the heart rate?

Answer 10

1 minute after administration

Question 11

Indications for epinephrine administration

Answer 11

BPM remains under 60 with at least 30 seconds of ventilation that moved the chest AND an additional 60 seconds of chest compressions (with concurrent PPV)

Question 12

When chest compressions need to happen, what other adjustments should be made?

Answer 12

Continue ventilation but increase oxygen to 100%

Question 13

What is the ratio of chest compressions to ventilation?

Answer 13

3 rapid chest compressions to 1 ventilation

“1 and 2 and 3 and breathe and…”

Question 14

After 1 minute of epinephrine admin, if the bpm is still under 60 what should you do?

Answer 14

Continue CPR and repeat the dose every 3-5 minutes + consider using a larger dose (initial is 0.02ml/mg)

Question 15

If volume expander is indicated, what is the recommended dosage/route/method?

Answer 15

10ml/kg steady infusion over 5 to 10 minutes (steady push or use a pump)

Question 16

What is a risk associated with giving a volume expander to a preterm baby?

Answer 16

Intracranial hemorrhage

Question 17

What are the two indications for a volume expander?

Answer 17

shock or a h(o) acute blood loss

Question 19

What is a reasonable time frame for cessation of neonatal resuscitation?

Answer 19

20 minutes

Question 20

What is a pneumothorax?

Answer 20

A collection of air in the pleural space surrounding the lung

Question 21

What are the consequences of a pneumothorax?

Answer 21

Tension pneumothorax = Lung collapse due to pressure from the pneumothorax which can result in interrupted blood flow and cause severe respiratory distress, desaturation and bradycardia

Question 22

Which babies are particularly at risk for pneumothorax associated with PPV?

Answer 22

Preterm babies, babies with mec aspiration and babies with other lung abnormalities

Question 23

What is transillumination and how can it be used when a pneumothorax is suspected?

Answer 23

Shining a high intensity light against the chest wall – the side with the pneumothorax will shine more brightly than the opposing side

Question 24

What will ultimately be needed in order to diagnose a pneumothorax?

Answer 24

A chest X-Ray

Question 25

What are some s/s of a pneumothorax?

Answer 25

• failure to improve despite resus measures
• sudden severe respiratory distress esp if baby had been improving with PPV
• decreased breath sounds on the side of the pneumothorax (although breath sounds could still be equal AND there can be other reasons for decreased breath sounds on one side)

Question 26

When might you suspect obstruction of the trachea when attempting PPV?

Answer 26

When ventilation correction steps fail to result in chest movement

Question 27

What are two ways to remove an airway obstruction?

Answer 27

Suction catheter directly in the endotracheal tube or a tracheal aspirator attached to the ET tube

Question 28

What is the evidence surrounding the use of Narcan in a newborn?

Answer 28

There is insufficient evidence to evaluate the safety/efficacy of Narcan use in the newborn – concerns of possible complications such as pulmonary edema, cardiac arrest and seizures