Paediatric Resuscitation Flashcards
Define the following:
a) Newborn
b) Neonate
c) Infant
d) Child
a) Just after birth
b) First 28 days
c) Up to 1 year
d) 1-15 years
Chest compressions on:
a) < 1yr
b) Small child
c) Larger child
a) 2 fingers
b) 1 hand heel
c) 2 hand heels
Chin lifts:
a) Under 1 year
b) Over 1 year
a) No chin lift; neutral
b) Slight chin lift
Paediatric CPR:
a) If breathing abnormality, begin with…?
b) If no signs of life after 10 seconds, commence…? (ratio)
c) Should you pause CPR?
a) 5 rescue breaths
b) CPR (15:2)
c) NO. Uninterrupted
Choking:
a) 3 signs of choking
b) If able to cough/talk
c) In infants - treatment
d) In children - treatment
a) Silent cough, cyanosis, patient gestures
b) Encourage coughing; monitor
c) 5 back slaps (use gravity), 5 chest thrusts, repeat and monitor
d) 5 back slaps, 5 abdo thrusts, repeat and monitor
Newborn Resus.
You are assessing a newly delivered infant on the delivery suite. What should you do first?
Dry and wrap baby in warm towels whilst undertaken assessment.
There is no need to take the baby to the resuscitaire. The baby can be assessed whilst attached to the placenta during this assessment, so that they benefit from a delay in clamping the cord.
Newborn Resus.
What initial assessment would you need to make?
Tone, breathing, heart rate
note: cyanosis is not a good initial predictor of hypoxia
Newborn Resus.
Once dried and wrapped you note he is floppy, not breathing with a slow heart rate. What should you do next?
Consider need for help, open airway, give 5 inflation breaths, consider SpO₂/ECG monitoring
(Note: Use of monitors should not delay resuscitation. Chest compressions should only be commenced when it is certain that the lungs have been successfully inflated. Babies who do not respond to normal drying and wrapping need CPR and not further stimulation.)
Newborn Resus.
After giving five inflation breaths you notice the baby’s chest has not moved. What should you do?
Consider need for help, re-check head position and consider use of jaw thrust to open airway, give a further five inflation breaths.
(note: Almost all babies will respond successfully to lung inflation. Chest compressions before aerating the lungs are useless. Airway obstruction is more likely to be due to incorrect positioning than mechanical obstruction and re-positioning needs to be considered first)
Newborn Resus.
Inflation breaths should only be given if the baby is gasping or not breathing after what three stages?
- Dried and covered
- Assessment of colour, tone, HR and breathing
- The head is placed in a neutral position
Newborn Resus.
Following re-positioning of the baby’s head, you see chest wall movement when repeating the inflation breaths. The heart rate remains slow at around 40bpm. What should you do next?
Ask for help, deliver ventilation breaths for 30 seconds and reassess.
The baby may need chest compressions after this and support will be required. A brief period of ventilation breaths will aerate the lungs further and will allow the baby’s heart a chance to respond.
Airway adjuncts are useful and should be considered if you fail to obtain chest movement, but in this instance chest movement has been obtained with the correct head positioning and/or jaw thrust.
Support needs to be called appropriate to care setting - paramedic ambulance or neonatal team. Since 2014, NLS UK guidance advises a period of ventilation breaths before commencing chest compressions.
Newborn Resus.
After 30 seconds of ventilation breaths. The chest continues to be seen moving and the heart rate has improved to >100bpm. The baby is making some respiratory effort. What two things should you do next?
Reassess the need for continuing face mask ventilation, commence pulse oximetry and keep the baby warm. Pulse oximetry will inform the decision to administer supplementary oxygen.
SBAR handover to neonatal team on arrival, keep the parents informed of events, record assessment and actions taken in the baby’s records. Concise handover and documentation is vital. Parents need to be informed of events. It is likely they will assess the baby and advise he remains with his mother
You must only give the baby to the Mum when you are happy that baby is in good condition.
Transfer to NICU may not be required following detailed assessment, the baby may be adequately observed by staying with mum. Encourage skin-to-skin contact and support early feeding
Newborn Resus.
When are chest compressions and rescue breaths indicated?
What ratio should be followed?
- Chest compressions with rescue breaths ratio 3:1
- Indicated if HR < 60bpm despite adequate aeration of lungs
Why should newborn babies be dried and wrapped immediately?
Why are they at risk of hypothermia?
Heat loss in a term newborn baby is primarily through evaporation, therefore the first action should be to dry and wrap the newborn baby in dry towels.
Because they are wet at birth and have a large surface area to weight ratio.
A midwife working in the community delivers a baby that is blue and floppy and has irregular reparations. In what order should she do the following?
- Dry and wrap the baby
- Initiate airway management
- Assess the colour, tone, breathing and heart rate
- Call for help (based on assessment)
- Call for help
- Dry and wrap the baby
- Assess the colour, tone, breathing and heart rate
- Initiate airway management
