Pre Resusc Equipment Checklist

Question 1

After warming What is the next step?

Answer 1

Therefore need
1 bulb syringe

2 10F or 12F Suction catheter attached to wall suction set at 80 to 100 mmHg
3 meconium aspirator

Question 2

Following clearance of the airway what is the next thing to do?

Answer 2

Auscultate

1 stethoscope

Question 3

After auscultating what is needed?

Answer 3

Oxygenation
1 Need to have a method to give free flow oxygen…
This can include: mask, tubing with cupped hand, flow inflating bag, or T piece
2 turn on gas is to have them flowing just prior to birth at 5 to 10 L per minute
3 blender set per protocol line
4 pulse exhibitor probe which is detached from oximeter until needed
5 pulse oximeter

Question 4

Following oxygenation, what is done?

Answer 4

Ventilation
Need:
1 positive pressure ventilation device with term and preterm masks
2 PPV device checked to be functioning
3 connected to air/oxygen source (blender)
4 8F feeding tube and 20 mL syringe

Question 5

What is the next step in resuscitation following ventilation?

Answer 5

Intubation.

1. Laryngoscope
   2 size 0 and size 1 (and size 00 optional) blades with bright light
   3 endotracheal tubes sizes 2.5, 3.0, 3.5, 4.0
   4 Stylettes
   5 end tidal CO2 detector
   6 laryngeal mask airway (size 1) and 5 mL syringe

Question 6

Following intubation what is done next?

Answer 6

Medication
1. 1:10,000 epinephrine and normal saline
2 supplies for administering meds and placing emergency umbilical venous catheter
3 documentation supplies

Question 7

After medication what is the last intervention for resuscitation?

Answer 7

Thermoregulation

1 Plastic bag or plastic wrap
2 chemically activated warming pad
3 transport incubator ready

Question 8

Under what situation can free flow oxygen not reliably be given by a mask?

Answer 8

When mask is attached to a self inflating bag.

Question 9

Under which situations should pulse oximetry be used?

Answer 9

Went resuscitation is anticipated
When PPV is required for more than a few breaths
When central cyanosis is persistent
When supplemental oxygen is administered
To confirm perception of cyanosis

Question 10

What is the first step?

Answer 10

Warm.

1 preheat the warmer
2 towels or blankets

Question 11

How to make it self inflating bag have a consistent oxygen concentration?

Answer 11

Must attach a reservoir to the gas inlet

Question 12

How to obtain PEEP with a self inflating bag?

Answer 12

Can be administered only if an additional valve is attached to the self inflating bag

Question 13

With a self inflating bag? How do you ensure that appropriate pressure is used when providing PPV for the newborn?

Answer 13

Use a self inflating bag that has an integral pressure gauge or, if there is a site for attaching a pressure gauge (manometer) make sure one is attached

Question 14

How does a flow inflating bag, also known as. An anesthesia baginflate?

Answer 14

It inflates only when A gas (air) from a compressed source is forced along with 100 O2 source into a blender and onward into the bag and the opening of the bag is sealed, such as when the mask is placed tightly on a baby’s face, or when the baby has been into beaded and the bag is attached to the endotracheal tube .

Question 15

What controls the Peak inspiratory pressure for the flow inflating bag?

Answer 15

Flow rate of incoming gas, adjustment of flow-control valve, and how hard the biggest being squeeze. Positive and expiratory pressure is controlled by an adjustable flow-control valve

Question 16

What are the characteristics of the t piece resuscitator?

Answer 16

It is flow controlled and pressure limited. It requires a compressed gas source.

Question 17

How are peak inspiratory pressure and positive and expiratory pressure (including CPAP) set in the t piece resuscitator?

Answer 17

They are manually set with adjustable controls. Breaths are delivered when the operator alternately occludes and opens the aperture on the device connected to the mask or endotracheal tube

Question 18

Advantages and disadvantages of the self inflating ventilation devices?

Answer 18

Self inflating is most common. Is easy and refills. Has a pop off valve that releases extra pressure above 40 to prevent over inflation. But specifications very with manufacturers and therefore only way to have a true sense of what pressure is being delivered a manometer is required. Disadvantage is that you are less likely to know if you have achieved a good seal between mask and babies face, and this is required for the pressure from the squeeze the bag to result in effect of gas flow delivered to babies lungs. Cannot be used to administer free flow or blow by oxygen reliably and cannot be used for CPAP. Regarding PEEP, this can only be done when a PEEP valve is added and pressurized gas is entering the bag.
Even when connected to 100% oxygen source, most of the oxygen is directed out of the back of the bag, and an unpredictable amount is directed toward the patient unless the biggest being squeezed. Therefore it’s requires an oxygen reservoir to deliver high oxygen concentration.

Question 19

Advantages and disadvantages of flow inflating bag?

Answer 19

Advantages are that they can deliver up to 100% oxygen, depending on the source. It is easy to determine when there’s a seal on the patient’s face because the bag with Phil. It can be used to deliver free flow oxygen at concentration up to 100%.
Disadvantages are that it requires a tight seal between the mask and the patient’s face. Flow will take the path of least resistance, either the patient outlet or the bag. Free flow oxygen delivery is possible up to 100% because the oxygen concentration that enters the bag is the same as that which exit it. Differentiate us from a self inflating bag which mixes patients expiration.
disadvantages include that a tight seal is required, I guess source is needed to inflate, and a pressure gauge to monitor pressure delivered with each breath is necessary. Essentially it takes more practice to use effectively.
Also, there is no safety valve so it is critical to watch for degree of chest movement with each assisted breath to avoid under or over inflation. The pressure being delivered can be adjusted using flow-control valve.
Requires more time to prepare because the compressor is needed to deliver gas to inflate the system.

Question 20

Advantages and disadvantages of T piece resuscitator?

Answer 20

Is similar to the flow inflating bag but there is also an added feature of mechanical control of airway pressures. There is no squeezing but rather mechanical adjustment. Gas flow is directed to the baby or the environment when you alternately occlude and open the aperture in the PEEP cap with finger or thumb.
Therefore this system provides the most consistent pressure with each breath and is not subject to operator fatigue. However, there is a risk of delivering longer than desired inspiratory time and monitoring duration of occlusion is critical.

Question 21

What mechanism is in place to prevent over inflation in the flow inflating system?

Answer 21

To prevent pressures from getting too high, flow inflating bags have a flow control valve which can be adjusted to deliver the desired PEEP. If the flow control valve is adjusted incorrectly it is possible to over inflate the babies lungs inadvertently. Therefore an attached pressure gauge also be used and care should be taken to ensure the oxygen supply line proximal to the flow control valve is not inserted at the distal site where the pressure manometer should be

Question 22

How can inspiratory pressure be adjusted for the t piece?

Answer 22

There are two controls.
1 inspiratory pressure control: sets the amount of pressure delivered during a normal assisted breath.
2 peak inspiratory pressure control: a safety feature that prevents the pressure from exceeding oppressed piece of value, usually 40 cm h20
A third mechanism of safety would be to watch the Circuit pressure gauge

Question 23

What is the most important indicator of success for resuscitation efforts?

Answer 23

Rising heart rate. Always assess for heart rate alongside the oxygen saturation if pulse oximetry is functioning when PPV is initiated

Question 24

What does one do if heart rate is not rising with PPV?

Answer 24

Assess for adequate ventilation by listening for bilateral breath sounds and chest movement. Even if baby is not responding with increased heart rate, this is considered effective.