Positive Pressure Ventilation (Lesson 4)

Question 1

When is PPV indicated? (assume you have already completed initial steps)

Answer 1

Apnea, gasping, HR < 100.

Question 2

For the initial resuscitation of newborns greater than or equal to 35 weeks gestation, what should the blender for oxygen be set at? Less than 35 weeks?

Answer 2

21% oxygen and 21% to 30% oxygen.

Question 3

Where should the pulse oximeter be placed on the newborn?

Answer 3

Pre-ductal or right hand.

Question 4

What ventilation rate should be used for PPV?

Answer 4

40 to 60 breaths per minute. Breathe, two, three, breathe, two, three.

Question 5

What is the starting Peak Inspiratory Pressure for PPV?

Answer 5

20 to 25 cm H2O. Some full term babies require higher pressure for the first few breaths (30-40)

Question 6

What should the peak end expiratory pressure be set at for PPV?

Answer 6

5 cm H2O

Question 7

For PPV, the flowmeter should be set at what rate? (L/min)

Answer 7

10 L/min

Question 8

If PPV was started for low HR, within how long would you expect the HR to start increasing?

Answer 8

15 seconds

Question 9

If mask ventilation is ineffective with PPV, what are the ventilation corrective steps (abbreviation)?

Answer 9

MR. SOPA. Mask readjustment. Reposition airway. THEN. Suction mouth and nose. Open mouth. THEN. Pressure increase. THEN. Alternative airway.

Question 10

PPV is initially ineffective without chest rise. You perform corrective measures and chest movement is achieved. How long do you continue PPV before reassessing the baby’s heart rate?

Answer 10

30 seconds

Question 11

What is the ideal position for baby’s head and neck to be in to achieve good PPV?

Answer 11

Neutral or slightly extended (the sniffing position)

Question 12

Baby has ineffective ventilation with no chest rise on PPV. You have completed steps MRSO without effect. You decide to increase the peak inspiratory pressure. How much should you increase the pressure by? What is the maximum amount of peak inspiratory pressure with face-mask ventilation?

Answer 12

In 5 to 10 cm H2O increments. Max PIP for term newborn is 40 cm H2O

Question 13

When is CPAP NOT appropriate during a resuscitation? (2 answers)

Answer 13

Baby is not breathing spontaneously OR HR is less than 100 bpm.

Question 14

What cm H2O should CPAP be set at? What is the maximum cm H2O for CPAP?

Answer 14

5 cm H2O. Max is 8 cm H2O.

Question 15

If a CO2 detector is detecting CO2, what color does it turn?

Answer 15

Yellow

Question 16

Name two disadvantages of the self inflating bag for resuscitation.

Answer 16

Cannot be used for CPAP. The mask cannot be used for free flow oxygen.

Question 17

When indicated, PPV should be started within how long from birth?

Answer 17

1 minute

Question 18

When can you discontinue PPV?

Answer 18

When the heart rate is continuously greater than 100 beats per minute and the baby has sustained spontaneous breathing.