Perkins #2 Flashcards
Methods of providing oxygen via blow-by
Blow-by slide- set the O2 at 5 liters and if you hold the supply tubing ½ in from the face you get 80% 1inch – 60% 2-inch – 40%
Initiation of positive pressure ventilation is done when…
Heart rate is less than 100, apnea or gasping
Procedure for intubation
Position- sniffing, 0 miller blade- premature, uncuffed tube, insertion distance of the tube is 7,8,9 Rule- if its 1kg infant you would insert the tube until the mark says 7, repeat for 2 (8)-3(9) kg infant.
On handout (Neo. Review)
Attempts are limited to 30 seconds
Size of catheters on neonates
- 2.5 tube -5 fr
- 3 tube- 6 fr
- 3.5 or 4- 8 fr
Initiation of chest compressions happens when..& what method do we use?
HR less than 60
HR is less than 100 with apnea or gasping
Thumbs are preferred
Indications for administration of Epinephrine and Narcan (naloxone)
If you have CPR going, and HR is still below 60 administer Epi- can give every 3-5 minutes
Narcan is given only if Respiratory Depression is because of narcotics
Rate of compressions to breaths
3 compressions : 1 breath
If it’s a cardiac baby do 15:2
Targeted Preductal SpO2 after 10 minutes
85-95%
over 95% can cause hyperoxia in preterm and can cause blindness (ROP)
Recent changes in NRP
Resuscitation guidelines: Use of the LMA CO2 detector Use 21% O2 with term newborn initially or slightly higher if premie. Use a pressure manometer with all bags. Intubation before compressions If intubation doesn’t work use an LMA Know all the answers on the NRP & ABG practice test
Indication for phototherapy
If bilirubin is 5-9 mg per 100 grams
Assessment of newborn’s cry
Normal is lusty
Abnormal is High pitched (CNS, chromosome abnormality)
Signs of respiratory distress
Gunting, retracting, flaring, and RR greater than 60
Conditions that cause shift of apical pulse
Pneumothorax
Atelectasis
Condition that causes cyanosis
Hypoxemia
Condition that causes yellowish hue to skin
Jaundice
Abnormality usually associated with an abnormal number of vessels in the cord.
Urinary Tract Abnormality
Classification of newborns by weight
SGA: Small gestational age 90% compared to all infants
AGA: Average/Appropriate 10-90%
Causes of: Murmur, dark green staining, frothy secretions, Pallor, Restractions, Abnormal Facial Features, Scaphiod abdomen, Abdonminal distention
Murmur: Patent Ductus Ateriosis or Patent Foramen Ovale
Green/dark green staining: meconium
Frothy secretions: TEF: Tracheal Esophageal Fistula
Pallor: Shock
Retractions: Respiratory Distress
Abnormal facial features: Alcohol Syndrome
Scaphoid abdomen: Diaphragmatic Hernia
Dubowitz scoring method
The Dubowitz scoring method determines gestational age when used within the first 5 days of birth
It is accurate within 2 weeks of the newborn’s gestational age.
The higher the score assigned, the greater the gestational age of the newborn
Ballard Scoring
The Ballard score includes 6 neuromuscular/neurologic and six physical signs.
Neuromuscular signs - posture, square window, arm recoil, popliteal angle, scarf sign, and heal to ear.
Physical signs - skin, lanugo, plantar creases, breast, ears, and genitals.
It assesses the most useful items from the Dubowitz scoring system.
Gestational age is assessable from 26 to 44 weeks
Purpose of the Dubowitz/Ballard
Accurate Gestational Age
Normal abdominal skin temperature
36-36.5
Clinical signs and treatment of of hypoglycemia, hypocalcemia, hypermagnesemia.
Hypocalcemia: Jittery, seizures, apnea
Hypermagnesemia: Lethary, Hypotonia (low muscle tone), apnea
Hypoglycemia: tremors, apnea, jittery, convulsions
Nebulizers used for Continuous Neb Therapy
Heart & Hope
Characteristics of periodic breathing
Intermittent respiratory pause for up to 10 seconds
HR doesn’t change
Apnea is 20s and there is a significant change in HR (brady) and color
Assessment of Fontanel
firm but soft
Neonatal tubes sizes
Less than 1000 grams = 2.5 1000 - 1500 grams = 3.0 1500 - 2500 grams = 3.5 Normal newborn = 3.5 - 4.0 6-12 months = 4.0 - 4.5
Proper position of Umbilical Artery Catheter – high and low
oHigh: T8
oLow: L3-4
Use of non-rebreathing mask
Special gas therapy- blender 02
Heliox therapy
Effectiveness of HMEs
Not as effective as uncuffed tubes
Use of DPIs in children
Used for kids 6 years and up
Good APGAR Score vs Good Silverman-Anderson Score.
APGAR: 10
SA: 0
Factors that decrease insensible water loss.
Decrease: oUse of heat shield oIncrease of environment humidification of dry gases oIncubation Increase: oAmbient Temp above NTE oRadiant warmer oPhototherapy
Trachypnea
> 60
Identify the score used to assess the neonate at one and five minutes.
APGAR
FIO2 achieved with a simple mask.
Tight fitting: 60-80%
Loose: 40%
Artery used to assess pulse in the labor/delivery room
umbilical
Use of a bulb syringe
Clear mouth & nose
Indication for incubator
Warm & quiet environment
Maintain NTE
Select appropriate device for long term oxygen therapy
cannula
FIO2’s of nasal cannulas
.25L 24-27%
.5L 26-32%
1L 30-35%
Use of an aerosol mist tent or croupette
Cool Aerosol and FiO2 < 50%
FiO2 fuction of total gas flow
Tent volume and tightness of seal
Min flow of 10-15 L/min
Advantages /disadvantages of MDIs and DPIs (On O2 worksheet)
Spacer can be used (MDI) Limited choice of drugs Slow inspiratory Flow Breath Hold to optimize distribution Easy to Use (MDI) Portable/efficient
Administration of aerosol therapy
<5-6 year old
If a child is babbling or laughing you get better aerosol deposition
With a mask or blow-by
Can cause infections
Administration of oxygen via hood – proper flowrates and temperature
Minimum flow 7L/min
Max 15 L/min
At or near body temp (min temp 32-34)
Airway clearance techniques – describe newer techniques
Fluttery valve (oscillatory PEP)
Acapella (oscillatory PEP)Huff Cough- FET (forced exp. Technique)
Autogenic Drainage (breathing at 3 diff levels)
High frequency chest wall Oscillation (Vest)
All of these are better than CPT because of fewer side effects and can do it themselves.
She will describe theses tx to us on a matching question
Treatment for hyperbilirubinemia
Bili Light (blue lights/shades in incubator)
Source of non-shivering thermogenesis
Brown Fat
Four mechanisms for losing heat and an example of each.
On the thermoregulation handout
Conduction: Loss of heat due to direct contact colder surface
Radiation: Loss of heat due to colder surface NOT in direct contact
Evaporation: Loss of heat due to evaporation from the skin
Convection: Loss of heat due to cooler surrounding air
Review ABG test
answers
Importance of infection control
IGG only immunity factor that crosses over from the placenta. Protects against gram negative bacteria
Diagnosis and management of NEC
Diagnosis: o Abdominal Distention o Ultrasound Management: o Withhold oral feedings o Surgery
