NRP Essentials Flashcards
What are the 3 indicators for PPV?
baby is apneic, bradycardic (HR less than 100) or gasping
Key different between resus for adults vs newborns
Adults - typically need resus r/t heart failure or trauma
Newborns - respiratory failure (before or after birth)
What is the worst case scenario for baby whose lungs are not well ventilated after birth?
Prolonged lack of adequate perfusion/oxygenation can result in organ damage and death
What is the most vital step in neonatal resus?
Ventilation of the lungs – baby cannot be resuscitated without this occuring first
Perinatal risk factors
- Gestational age less than 36 weeks and more than 41 weeks
- Preeclampsia
- Maternal hypertension
- Multiple gestation
- Fetal anemia
- Poly/Oligo Hydramnios
- Fetal Hydrops
- Fetal macrosomnia
- IUGR
- Sig fetal malformations or anomalies
- No prenatal care
- Emergency c-section
- Forceps or vacuum delivery
- Breech presentation
- Category 3 or 4 FHR pattern
- Maternal General Anesthesia
- Maternal Mag admin
- Placental Abruption
- Intrapartum bleeding
- Chorioamnionitis
- Shoulder dystocia
- Opioid admin w/in 4 hours of delivery
- Mec stained amniotic fluid
- Prolapsed cord
When mec stained fluid is the only risk factor how many individuals with resus skills should be available?
At least 2 skilled providers whose only job is to attend to the baby
What if there is mec stained fluid and additional risk factors….how many qualified individuals should be present?
The full resus team = 4 individuals
Delayed Cord Clamping: How long does the evidence support? why?
At least 30-60 seconds because as long as maternal blood is flowing to the placenta and the umbilical cord is not clamped, placental gas exchange will continue and oxygenated blood will continue to flow to the baby
What are some other benefits of delayed cord clamping?
In both term and preterm babies, may improve hematologic measurements and possible neuro-developmental benefit
What are the 5 initial steps of newborn care?
1) Warmth
2) Dry + take away wet linens
3) Stimulate (gentle rubbing of back and extremities)
4) Sniffing position - position head and neck to open the airway
5) Clear Secretions (as needed)
What does MR. SOPA stand for?
Mask adjustment (one hand to two)
Reposition Head
Suction mouth and nose
Opened mouth
If you do the first four steps of MR. SOPA and there is still no chest movement (even if there is an increase in heart rate) what is the next step?
Increase the pressure in 5-10 increments up to 40 cm H20
If baby is breathing after initial steps of newborn care – what is the next step?
Evaluation of heart rate - should be at least 100bpm
What are the three steps for rapid evaluation of the newborn that determine whether the 5 initial steps of newborn care can occur on the mothers chest or if baby should be moved to the warmer?
Term, Tone, Breathing
What is included in the bundle of Laryngeal Mask supplies?
Size 1 Laryngeal mask, Co2 detector, 8F Feeding tube + syringe for use as orogastric tube if needed, 5mL syringe (for mask inflation if needed)
Indications for Laryngeal mask use
1) When mask ventilation and/or endotracheal intubation are not feasible or unsuccessful
2) When there are congenital abnormalities involving mouth, lip, tongue, palate, neck
3) Newborn has small mandible or large tongue
Trisomy 21 or Pierre Robin Sequence - “Pierre Robin sequence is a rare birth defect characterized by an underdeveloped jaw, backward displacement of the tongue and upper airway obstruction”
How does a laryngeal mask work?
As an alternative airway
Limitations of laryngeal mask
Meant to fit babies 2000g or larger but may fit babies as big as 1500
No studies to backup use of this mask with suction
Air leakage with high pressure
Not many reports of use with chest compressions although this may be reasonable
No sufficient evidence for administration of intratracheal medication
If you find yourself doing PPV alone, you should still start but mobilize help. Ideally you’ll have at least two other people join who would be doing what two things?
1 person monitors heart rate and places pulse ox on baby’s right hand. The other person charts vital signs/interventions every 30-60s (including respiratory effort, heart rate, oxygen saturation, oxygen concentration in use, chest movement)
What is the most important indicator of successful PPV?
A rising heart rate
When doing PPV when would you proceed to cardiac compressions and/or medication?
Until the newborn receives 30 seconds of PPV that moves the chest
Why might you want to use an orogastric tube?
When using a face mask or a laryngeal mask, air can enter the esophagus and/or stomach, which can interfere with ventilation – if you are doing PPV for more than a few minutes consider placing an orogastric tube and leaving it uncapped to vent the stomach
How do you appropriately measure an orogastric tube?
Bridge of the nose to the earlobe and earlobe to the midway point between the xiphoid process and the umbilicus
How do you know if a pulse oximeter is reliable?
It detects a pulse with each heartbeat
What are the target sat levels for 1, 2, 3, 4, 5 and 10 minutes
1 60-65%
2 65-70%
3 70-75%
4 75-80%
5 80-85%
10 min 85%-95%
When should supplemental oxygen be given?
When oxygen saturation is lower than the target rate and baby is breathing with a heart rate of at least 100bpm
When supplemental oxygen is indicated, where is it reasonable to start?
at 30% and then guided by pulse oximetry, adjust Fi02 to maintain the baby’s oxygen sat within the target range for the baby’s age in minutes
What is the ultimate goal with supplemental oxygen administration?
Prevent lower O2 sat than is within range according to baby’s age (in minutes) while preventing potential risks associated with unnecessary oxygen
When you first administer free flow oxygen, what are the setting placed at?
Start at 10L/min, set oxygen blender to 30% and monitor oxygen saturation + adjust concentration as needed to maintain within target range
How can oxygen be delivered with a self inflating bag?
Through the tail
What are the four ways free flow oxygen can be given?
1) Holding the mask of the T-piece resuscitator close to the baby’s mouth and nose
2) Holding the mask of the flow inflating bag close the baby’s mouth and nose
3) Through the tail of the self inflating bag
4) Oxygen tubing OR oxygen facemask
What is an appropriate rhythm when using a self inflating mask?
Waltzing rhythm: Breath-2-3
When using a self inflating mask, what inspiratory pressure should you start at?
20-25 cmH20
What inspiratory pressure may a full term baby require?
Up to 30-40 cmH20
If you cannot maintain a good seal with the self inflating mask, what adjustment should be made?
Use two hands instead of one – hold mask against face with thumb and first fingers, the other fingers should be placed under the angle of the mandible and instead of pushing down on the mask you should bring the jaw forward toward the mask + hold head in sniffing position. A second person would then administer the breaths and a third person is monitoring the heart rate and chest movement
How can a Co2 detector be helpful when giving breaths?
Turns yellow when Co2 is detected, indicating ventilation that is inflating the lungs. Should occur by 8-10 breaths.
What is the benefit of a t-piece resuscitator compared to the self inflating bag
Delivers consistent inspiratory pressure and PEEP
What does PEEP do?
Helps achieve stable lung inflation, removes fluid and prevents air spaces from collapsing during exhalation
Who especially benefits from PEEP during assisted ventilation?
Preterm babies
What are the appropriate PEEP settings?
5cm water, 21% oxygen (room air)
When doing PPV when should the first heart rate assessment occur?
After 15 seconds; assistant should announce if the heart rate is increasing or not increasing and if the chest is moving or not moving
What are two things you are looking for when doing PPV?
Acceleration of the heart rate and chest movement
During PPV: If heart rate is increasing, what do you do?
Continue PPV and assess HR again in 15 seconds – do not need to do corrective steps to obtain chest movement
During PPV: what do you do if the heart rate is not increasing but the chest is moving?
Continue PPV and assess the heart rate after another 15 seconds of PPV that moves the chest
With babies greater than 35 weeks gestation, what should the oxygen setting be at with PPV?
21% (room air)
With babies less than 35 weeks gestation, what should the oxygen setting be set at with PPV?
21-30%
During PPV: what do you do if the heart rate is NOT increasing and the chest is also NOT moving?
Begin MR. SOPA ventilation corrective steps
When doing PPV what is the correct ventilation rate?
40-60 breaths/minute
