NRP Advanced (Chapters 5-11) Flashcards
What are the indications for endotracheal intubation?
if baby’s heart rate is persistently under 100bpm and not increasing with PPV
What would ideally happen first before chest compressions begin?
Endotracheal Intubation
What can be used in lieu of endotracheal intubation and in what specific circumstance?
If endotrachael intubation is not successful or feasible and baby weighs at least 1500-2000g (3-4ishlbs)
Other indications for endotracheal intubation?
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
What are the indications for chest compressions?
- persistent bpm under 60 with ventilation that has moved the chest for at least 30 seconds preferably with an alternative airway
What is the preferred route of epinephrine administration?
intravenous into the umbilical vein
Why is the intravenous route preferred over the endotracheal route for epinephrine administration?
studies have shown that the absorption of epinephrine via the endotracheal route is unreliable
What is the epinephrine concentration used for newborn resus?
0.1mg/ml (or 1mg/10ml)
What is the recommended initial dose of epinephrine used for newborn resus?
0.02mg/mL (or 0.2g/10mL)
After epinephrine admin when do you reassess the heart rate?
1 minute after administration
Indications for epinephrine administration
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)
When chest compressions need to happen, what other adjustments should be made?
Continue ventilation but increase oxygen to 100%
What is the ratio of chest compressions to ventilation?
3 rapid chest compressions to 1 ventilation
“1 and 2 and 3 and breathe and…”
After 1 minute of epinephrine admin, if the bpm is still under 60 what should you do?
Continue CPR and repeat the dose every 3-5 minutes + consider using a larger dose (initial is 0.02ml/mg)
If volume expander is indicated, what is the recommended dosage/route/method?
10ml/kg steady infusion over 5 to 10 minutes (steady push or use a pump)
What is a risk associated with giving a volume expander to a preterm baby?
Intracranial hemorrhage
What are the two indications for a volume expander?
shock or a h(o) acute blood loss
What is a reasonable time frame for cessation of neonatal resuscitation?
20 minutes
What is a pneumothorax?
A collection of air in the pleural space surrounding the lung
What are the consequences of a pneumothorax?
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
Which babies are particularly at risk for pneumothorax associated with PPV?
Preterm babies, babies with mec aspiration and babies with other lung abnormalities
What is transillumination and how can it be used when a pneumothorax is suspected?
Shining a high intensity light against the chest wall – the side with the pneumothorax will shine more brightly than the opposing side
What will ultimately be needed in order to diagnose a pneumothorax?
A chest X-Ray
What are some s/s of a pneumothorax?
- 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)
When might you suspect obstruction of the trachea when attempting PPV?
When ventilation correction steps fail to result in chest movement
What are two ways to remove an airway obstruction?
Suction catheter directly in the endotracheal tube or a tracheal aspirator attached to the ET tube
What is the evidence surrounding the use of Narcan in a newborn?
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
