Obstetrics (Neonatal resuscitation) Flashcards

1
Q

What is the key to newborn resuscitation?

A
  • effective ventilation
  • the majority of newborns requiring resuscitation are apnoea and bradycardia due to ineffective ventilation
  • priorities establishing and maintaining effective ventilation at each stage of resuscitation
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2
Q

What is the best indicator of effective ventilation?

A
  • improvement of HR >100bpm
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3
Q

How quickly should ventilation be initiated for the management of the non-vigorous newborn?

A

60 seconds

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4
Q

At what rate should ventilations be delivered? and how do you know if they are effective?

A
  • 40-60 per minute
    • enough pressure to see the chest rise
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5
Q

When should you apply PEEP and how much?

A
  • where appropriate equipment is available, apply PEEP (5cmH2O) whenever positive pressure ventilation is being provided
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6
Q

What should you do if the neonates HR remains between 60-100 bpm after 30 seconds of effective ventilation on room air?

A
  • ensure adequate mask seal and airway position
    • increase ventilation pressure
    • where HR remains <100, 100% FiO2 oxygen (5L/min) should be administered
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7
Q

What do you do in regard to O2 if HR >100 and target sats are being met?

A

Wean O2 to avoid hyperoxaemia

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8
Q

What do you do if the HR <60 despite 30 seconds of effective ventilation?

A
  • commence CPR with 100% oxygen
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9
Q

What are the indications for withholding resuscitation?

A
  • <23 weeks gestation - as there is no possibility of successful resuscitation. Where there is any doubt as to the gestation of the newborn, paramedics should attempt resuscitation and consult with PIPER
  • While resuscitative efforts may not be required it is a legal requirement in Victoria that any infant born >20 weeks gestation of >400g at birth OR showing signs of life regardless of gestation, be registered by a hospital, medical facility or midwife.
  • There is no requirement that miscarriages <20 weeks gestation be reported to the coroner or police unless the loss of pregnancy has occurred due to violence or injury
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10
Q

How do you manage a neonates airway position?

A

The head and neck should be placed in a neutral position. Avoid flection and excessive head extension. This will likely require placing a folded towel or blanket underneath the shoulders

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11
Q

When is suctioning required in neonatal resus?

A
  • only when the airway is obstrcuted
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12
Q

How do you suction a neonate?

A
  • the mouth should be suctioned first, followed by the nose.
    • the newborn is a nasal breathing and may gasp and inhale pharyngeal fluid if the nose is cleared first
    • suction should be gentle, brief (5-6 seconds) and no deeper than the oropharynx (measured from the tragus to the corner of the mouth) to avoid laryngospasm and bradycardia
    • a size 10 or 12 catheter with approx <100mmHg or ¼ the adult pressure of suction should be applied
    • only apply suction as the catheter is being withdrawn;
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13
Q

When do you suction an intubated neonate?

A

if the newborn is intubated - only consider tracheal suction is a lower airway obstruction (meconium or blood) is suspected)

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14
Q

Can you use an OPA in a neonate?

A
  • OPAs are not recommended as they may cause airway obstruction and vaguely mediated bradycardia
  • a size 0 may be useful where airway abnormalities or the tongue impedes effective ventilation
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15
Q

How do you measure a neonates HR?

A
  • by auscultation in the vigorous newborn (preferred method in preterm newborns <28 weeks)
  • in the non-vigorous newborn ECG electrodes can be placed to guide resuscitation (be mindful electrodes can damage their skin)
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16
Q

Do you shock a newborn?

A
  • shockable newborns are extremely rare in newborns. Should these rhythms be observed, apply multifunction electrode pads and defibrillate in manual mode using 4J/kg at 2 min intervals
17
Q

Where do you attach the pulse oximetry on a new born?

A
  • Attach it to the right hand or right wrist (pre-ductal)
18
Q

How do you administer CPR to the newborn?

A
  • 3:1 compression to ventilation
  • achieve 90 compressions and 30 ventilations per minute with a 0.5 second pause for ventilation (120 events per minute)
  • Compression depth should be approximately ⅓ depth of the chest
  • the two thumb technique is preferred
  • the two finger technique may be performed if access to the tibia for IO is required
19
Q

What is the focus for a single rescuer?

A
  • the focus should be provided on effective positive pressure ventilation until back up arrives
20
Q

Recite the newborn resuscitation CPG

21
Q

What are normal values for a newborn baby?

22
Q

What is a APGAR score and how is it scored?

23
Q

What is the purpose of an APGAR score?

A
  • to guide resuscitation
24
Q

When should the APGAR score be conducted?

A
  • At 1 minute and 5 minutes post birth
  • Repeat at 5 min intervals until APGAR score >7
25
What is a satisfactory APGAR score?
7-10
26
What is an APGAR score that identifies respiratory depression and that the patient may require ventilation?
4-6
27
What is the APGAR score that suggests requirement of ongoing resuscitation?
* 0-3
28
What do you do if the baby is apnoeic or gasping or has no muscle tone?
* stimulate by drying (no more than 30 seconds) * maintain warmth * place supine with head/neck in neutral position * suction only if airway obstruction is suspected
29
How long do you stimulate a newborn baby before attempting resuscitation?
No more than 30 seconds
30
What do you do if the babies HR is \<100 and/or apnoeic or gasping
* IPPV 40-60 per minute on room air * pulse oximetry (right hand or right wrist) * ECG monitoring if not already attached * reassess after 30 seconds
31
What do you do if the babies HR is \<60
* commence CPR * 3:1 ratio with oxygen 5L/min * Consult with PIPER * MICA
32
What do you do if the babies HR is 60-100
* IPPV at 40-60 breaths per minute * ensure adequate mask seal, airway position and increase ventilation pressure targeting chest rise * If no increase in HR * IPPV with O2 5L/min
33
What do you do if the babies HR is \>100 but SpO2 \<90 and their breathing is laboured?
* IPPV @ 40-60 per minute * titrate O2 1-5L/min to meet target saturations
34
What do you do if the babies HR is \> 100 but SpO2 \<90 and they're breathing normally
* maintain warmth and treat as per newborn aby * Titrate oxygen to 1-2 L/min via nasal cannula to meet target saturations * discontinue oxygen when SpO2 \>90