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11 Neonatology > NRP and EINC > Flashcards

NRP and EINC Flashcards

1
Q

newborns that are not problematic should be __

A

crying and/or moving all the extremities

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2
Q

signs of a compromised newborn

A 
poor muscle tone (should be flexed)
slow or no breathing
low hr
low bp
fast breathing
cyanosis
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3
Q

t/f secondary apnea can be reversed with stimulation

A

false, needs assisted ventilation

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4
Q

antepartum risk factors for resuscitation

A

gestational age less than 35 6/7 weeks or greater than 41 weeks
polyhydramnios
oligohydramnios

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5
Q

intrapartum risk factors for resuscitation

A 
emergency cs
forceps or vacuum assisted delivery
maternal general anes
placental abruption
chorioamnionitis
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6
Q

if there are risk factors present ___ qualified people should be present

A

2

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7
Q

what is done before the delivery

A

antenatal counseling, team briefing, equipment check, room temp check

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8
Q

4 core steps of einc in normal delivery

A

immediate and thorough drying
early skin to skin contact
properly timed cord clamping
non-separation of the mother and baby

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9
Q

4 steps of einc in cs delivery

A

immediate and thorough drying
cord clamping
skin to skin contact when possible

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10
Q

how long to dry baby

A

at least 30 seconds
face and head, trunk and back, extremities
also assess baby at this time

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11
Q

benefits of immediate drying

A

stimulates breathing

prevents hypothermia

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12
Q

t/f it’s okay to slap, shake, or rub the baby

A

false

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13
Q

t/f ventilation and suction is required during immediate drying

A

false, done only if indicated (floppy/limp or blocked mouth/nose)

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14
Q

ideal room temp

A

25-28 c

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15
Q

benefits of skin to skin contact

A

BLEST

breastfeeding success
lymphoid tissue system stimulation
exposure to maternal skin flora
sugar (protection from hypogly)
thermoregulation
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16
Q

benefits of properly timed cord clamping

A

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%)

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17
Q

how often to monitor baby and mother

A

never leave unattended, monitor every 15 mins for the first 1-2 hrs

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18
Q

t/f skin to skin contact is still allowed for covid-19 positive/suspect mothers

A

true

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19
Q

what to do if baby is apneic/gasping or limp in the first minute

A 
call for help
change wet linen
clamp and cut the cord
transfer to warmer
position airway
clear secretions
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20
Q

t/f suction nose before mouth

A

false, mouth before nose

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21
Q

indications for pulse oximetry

A

when resuscitation is anticipated
to confirm suspicion of persistent central cyanosis
when supplemental o2 is administered
when ppv is required

22
Q

indications for ppv

A

apneic/gasping
hr <100 bpm
persistent central cyanosis and saturation remains below target values despite 100% o2

23
Q

t/f ventilation of the lungs is the single most important and most effective step in cardiopulmonary resuscitation of the infant

A

true

24
Q

target pre-ductal o2

A

1 min = 60-65%
5 min = 80-85%
10 min = 85-95%

25
Q

signs of effective ventilation

A

signs of adequate ventilation = bilateral breath sounds, chest movements

signs of improvement in newborn = imporved hr, improved o2 sat, onset of spontaneous respiration

26
Q

ventilation corrective steps

A

MRSOPA

mask adjustment
reposition airway
suction
open mouth
pressure increase
airway alternative
27
Q

what to do when baby is apneic/gasping or hr <100 bpm

A

ventilation corrective steps

intubate if needed

28
Q

what to do if baby has labored breathing or persistent cyanosis

A

position and clear airway
spo2 monitoring
consider cpap

29
Q

what to do if hr <60 bpm

A

intubate
coordinated ppv and chest compressionis
100% o2
consider uvc insertion

30
Q

indications for ppv and chest compressions

A

ppv: <100 bpm

ppv + chest compressions: <60 bpm despite 30 s of ppv

31
Q

compression techniques

A

thumb technique and two finger technique

32
Q

compression-ventilation rhythm

A

90 compressions and 30 breaths per minute
120 events per minute

1-and-2-and-3-and-breathe

33
Q

complications of chest compressions

A

lacerations of major organs

broken ribs

34
Q

when to stop compressions and ppv

A

stop compressions when hr is >60 bpm

stop ppv when hr >100 bpm

35
Q

indications for intubation

A
  • chest compressions, doing prolonged ppv
  • stabilization of newborn with suspected diaphragmatic hernia
  • surfactant administration
  • direct tracheal suctioning if airway is obstructed by thick secretions
36
Q

t/f always hold the laryngoscope with the right hand

A

false, left hand

37
Q

appropriate blades for laryngoscope

A

blade 1 term
blade 0 preterm
blade 00 extremely preterm

38
Q

guide for inserting the et tube

A

vocal cords (v-shaped structure)

39
Q

what is ntl method

A

length of nasal septum to ear tragus

estimated insertion depth = ntl+1

40
Q

signs of correct tube position

A

BIN

improved vital signs
breath sounds over both lung fields but decreased/absent over stomach
no gastric distention with ventilation

41
Q

problems to consider if baby worsens post intubation

A

DOPE

Displaced endotracheal tube
Obstructed endotracheal tube
Pneumothorax
Equipment failure

42
Q

what to do if hr is <60 bpm despite adequate ventilation and chest compressions

A

iv epi
consider hypovolemia
consider pneumothorax

43
Q

indication for medication administration

A

hr <60 despite 30 s of adequate ventilation and chest compressions

44
Q

how to administer epi

A

uv catheterization -> insert epi

45
Q

after delivery, if the hr of the newborn is 60, first action is

A

ppv

46
Q

indications for volume expansion

A

baby is not responding to resuscitation
baby appears in shock
hx of fetal blood loss

47
Q

how to administer volume expansion

A

normal saline (0.9% NaCl) IV or intraosseous over 5-10 mins, 10 ml/kg via umbilical vein

48
Q

expected response from volume expansion

A

increased hr
stronger pulses
less pallor
increased bp

49
Q

t/f persistent cyanosis is usually caused by bradycardia

A

false, rarely caused by bradycardia, caused by inadequate ventilation

50
Q

t/f the persistent absence of detectable hr (apgar 0) at 10 mins is a strong predictor of mortality and serious morbidity

A

true

11 Neonatology (9 decks)

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