NRP Medications & Algorithm

Question 1

Epinephrine: What is the concentration & dose used during NRP?

Answer 1

Concentration: 0.1mg (100mcg) per 1 mL (from 1:10,000 preload)

IV/IO Dose: 0.01 to 0.03 mg/kg
- (Q 3-5 min, if HR <60/min despite adequate PPV & compression)

ETT Dose: 0.05 to 1mg/kg

Question 2

Volume Expanders: What type of fluid is used & what is the dose?

Answer 2

ACLS fluid: isotonic crystalloid (NS) or blood

IV/IO Dose: 10 to 20mL/kg
- Max 2 increments of fluid bolus’ (each 10ml/kg) = max 20ml/kg
- Give each bolus over 5-10min (reassess after each bolus)
- Indicated for S/s shock (no improvement to HR despite multiple EPI doses, CC, adequate PPV)

Question 3

Dextrose D10W: What is the concentration & dosing used post NRP? (special consideration)

Answer 3

Concentration: 0.1g/mL (100mg/mL) (250mL D10W = 25g)

IV/IO Loading Dose: 0.2g/kg
(Followed by Infusion Dose: 5mL/kg/hr)

• Indicated for BGL < 2mmoL/L
• Check BGL 20min post bolus
• • weight based dosing: 3kg x 0.2g = 0.6g = 6mL D10W

Question 4

Ventilation & Compression ratios during NRP?

Answer 4

Ventilation rate: 40-60 b/min or 1b q 2sec (1/10 of infant BVM) = prior to chest compression

Compression rate: 90:30 (120 events PER MINUTE)

Compression to Vent ratio: 3:1
(pause CC for ventilation …. 1 & 2 & 3 & breathe, etc)

• Only add 100% O2 to PPV once compressions have started
• Pulse Ox applied to pre-ductal R-hand
• ECG monitor on by this point = HR more accurate on monitor (dont use pulse ox for HR accuracy = poor perfusion)

Question 5

MR SOPPA during NRP

Answer 5

M- Mask to face
R- Reposition head (sniff position) (AHA no longer recommends towel under shoulders)
—— reassess with 5 breaths ——
S- Suction mouth (then nose)
O- Open mouth, jaw thrust
—— reassess with 5 breaths ——
P- initial PIP via BVM 20-25cm H20 pressure
P- pressure increases 5-10cmH20 = max 30-40cmH20
—— reassess with 5 breaths ——
A- Alternative airway placement (OPA - iGEL - ETT)
—— reassess with 5 breaths ——

• This is done on RA (no supplemental O2)
• Must have chest rise before moving on to chest compression (if HR remains <60/min) other wise indicative of airway obstruction

Question 6

NRP indicators?

Answer 6

Stable: Term 3 gestation, good tone, good breathing/crying (give to mom & delay cord clamp)

Unstable:
- Post 30 sec stimulation (dry/warm, airway clearance or reposition) & no evidence of tone adequate breathing
1. Apnea or gasping (count RR)
2. Count HR
+100/min, reposition/re clear airway, monitor, CPAP)
< 100/min = PPV, SpO2, heart monitor = 15sec
—–recheck—-
<100/min = MR SOPPA (includes if HR < 60) = 30sec
—–recheck—-
<60/min = begin CC, add 100% O2 = 1 min
—–recheck—-
<60 = administer EPI
—–recheck—-
persistent <60 despite multiple EPI = consider hypovolemia or T pneumo
add Volume expander or chest decompress