NRP and EINC Flashcards
newborns that are not problematic should be __
crying and/or moving all the extremities
signs of a compromised newborn
poor muscle tone (should be flexed) slow or no breathing low hr low bp fast breathing cyanosis
t/f secondary apnea can be reversed with stimulation
false, needs assisted ventilation
antepartum risk factors for resuscitation
gestational age less than 35 6/7 weeks or greater than 41 weeks
polyhydramnios
oligohydramnios
intrapartum risk factors for resuscitation
emergency cs forceps or vacuum assisted delivery maternal general anes placental abruption chorioamnionitis
if there are risk factors present ___ qualified people should be present
2
what is done before the delivery
antenatal counseling, team briefing, equipment check, room temp check
4 core steps of einc in normal delivery
immediate and thorough drying
early skin to skin contact
properly timed cord clamping
non-separation of the mother and baby
4 steps of einc in cs delivery
immediate and thorough drying
cord clamping
skin to skin contact when possible
how long to dry baby
at least 30 seconds
face and head, trunk and back, extremities
also assess baby at this time
benefits of immediate drying
stimulates breathing
prevents hypothermia
t/f it’s okay to slap, shake, or rub the baby
false
t/f ventilation and suction is required during immediate drying
false, done only if indicated (floppy/limp or blocked mouth/nose)
ideal room temp
25-28 c
benefits of skin to skin contact
BLEST
breastfeeding success lymphoid tissue system stimulation exposure to maternal skin flora sugar (protection from hypogly) thermoregulation
benefits of properly timed cord clamping
ATB
decrease in anemia in term (80%) and preterm babies (51%)
decreased need for blood transfusions in premature
decreased bleeding in the brain in premature (51%)
how often to monitor baby and mother
never leave unattended, monitor every 15 mins for the first 1-2 hrs
t/f skin to skin contact is still allowed for covid-19 positive/suspect mothers
true
what to do if baby is apneic/gasping or limp in the first minute
call for help change wet linen clamp and cut the cord transfer to warmer position airway clear secretions
t/f suction nose before mouth
false, mouth before nose
indications for pulse oximetry
when resuscitation is anticipated
to confirm suspicion of persistent central cyanosis
when supplemental o2 is administered
when ppv is required
indications for ppv
apneic/gasping
hr <100 bpm
persistent central cyanosis and saturation remains below target values despite 100% o2
t/f ventilation of the lungs is the single most important and most effective step in cardiopulmonary resuscitation of the infant
true
target pre-ductal o2
1 min = 60-65%
5 min = 80-85%
10 min = 85-95%
signs of effective ventilation
signs of adequate ventilation = bilateral breath sounds, chest movements
signs of improvement in newborn = imporved hr, improved o2 sat, onset of spontaneous respiration
ventilation corrective steps
MRSOPA
mask adjustment reposition airway suction open mouth pressure increase airway alternative
what to do when baby is apneic/gasping or hr <100 bpm
ventilation corrective steps
intubate if needed
what to do if baby has labored breathing or persistent cyanosis
position and clear airway
spo2 monitoring
consider cpap
what to do if hr <60 bpm
intubate
coordinated ppv and chest compressionis
100% o2
consider uvc insertion
indications for ppv and chest compressions
ppv: <100 bpm
ppv + chest compressions: <60 bpm despite 30 s of ppv
compression techniques
thumb technique and two finger technique
compression-ventilation rhythm
90 compressions and 30 breaths per minute
120 events per minute
1-and-2-and-3-and-breathe
complications of chest compressions
lacerations of major organs
broken ribs
when to stop compressions and ppv
stop compressions when hr is >60 bpm
stop ppv when hr >100 bpm
indications for intubation
- chest compressions, doing prolonged ppv
- stabilization of newborn with suspected diaphragmatic hernia
- surfactant administration
- direct tracheal suctioning if airway is obstructed by thick secretions
t/f always hold the laryngoscope with the right hand
false, left hand
appropriate blades for laryngoscope
blade 1 term
blade 0 preterm
blade 00 extremely preterm
guide for inserting the et tube
vocal cords (v-shaped structure)
what is ntl method
length of nasal septum to ear tragus
estimated insertion depth = ntl+1
signs of correct tube position
BIN
improved vital signs
breath sounds over both lung fields but decreased/absent over stomach
no gastric distention with ventilation
problems to consider if baby worsens post intubation
DOPE
Displaced endotracheal tube
Obstructed endotracheal tube
Pneumothorax
Equipment failure
what to do if hr is <60 bpm despite adequate ventilation and chest compressions
iv epi
consider hypovolemia
consider pneumothorax
indication for medication administration
hr <60 despite 30 s of adequate ventilation and chest compressions
how to administer epi
uv catheterization -> insert epi
after delivery, if the hr of the newborn is 60, first action is
ppv
indications for volume expansion
baby is not responding to resuscitation
baby appears in shock
hx of fetal blood loss
how to administer volume expansion
normal saline (0.9% NaCl) IV or intraosseous over 5-10 mins, 10 ml/kg via umbilical vein
expected response from volume expansion
increased hr
stronger pulses
less pallor
increased bp
t/f persistent cyanosis is usually caused by bradycardia
false, rarely caused by bradycardia, caused by inadequate ventilation
t/f the persistent absence of detectable hr (apgar 0) at 10 mins is a strong predictor of mortality and serious morbidity
true
