Reanimación Neonatal Flashcards
what is the best guideline for staffing the resuscitation team for a delivery
When resuscitation is anticipated, additional personnel will be in the delivery room before birth
at the tme of birth which 3 questions should you ask about the newborn while you are assessing the need of resuscitation
Is the baby of term gestation ?, Is The baby breathing or crying?, does the baby have good muscle tone?
Approximately what percent of newborns require some assistance to begin breathing at birth?
10%
which of the following best describes the initial steps
Provide warmth , position of the head and clear airway , dry and stimulate.
Evaluation and decision making during resuscitation are primarily based on which combination of signs?
Respiration, heart rate, color
What percent of newborns require initial assessment to determine whether resuscitation is required?
100%
What are the “ABCs of resuscitation”?
Airway, breathing, and circulation
A baby who requires intubation and positive pressure in the delivery room responds well within 10 minutes .What kind of care should this bay now receive?
Post-resuscitation.
An apneic newborn has not responded to suctioning, drying, and rubbing of the back. What is the appropriate next action?
Begin positive-pressure ventilation
Which of the following are acceptable methods of stimulating a newborn to breathe?
- Shake the newborn vigorously.
- Dry with a warm towel.
- Rub the newborn’s back gently.
- Flick the soles of the feet.
2, 3, 4
Which figure best “represents the “sniffing” position that allows unrestricted opening of the airway?
45°
A baby has been suctioned dried and stimulated and still has not initiated breathing efforts. For apparent secondary apnea, what should be done next?
Begin positive-pressure ventilation
During a resuscitation , the team makes decisions about the baby’s progress primarily based on 3 findings. Which findings are used?
Respirations, heart rate, color
After undergoing the initial steps of resuscitation , a newly born baby s spontaneously breathing and has a heart rate of 140 beats per minute , However, persistent central cyanosis is noted , what is the appropriate action ?.
Administrate supplementary oxygen if needed.
In a normal newborn the So2 must raise up to 90% in:
10 minutes
What is the single most important and most effective step in cardiopulmonary resuscitation of the compromised newborn?
Ventilation of the lungs
A newborn is being ventilated with a bag and mask. Which are signs of effective positive-pressure Ventilation?
Increased heart rate, Improvement in color and tone
What needs to be attached to a self-inflating bag to deliver 90% to 100% oxygen?
An oxygen reservoir
Which are indications to initiate positive-pressure ventilation?
Persistent cyanosis despite 100% free-flow oxygen; heart rate remains less than 100 beats per minute, even if the baby is breathing; apnea or gasping
A T-piece resuscitator is characterized by which of the following?
The operator sets the maximum circuit pressure, peak inspiratory pressure, and positive end-expiratory pressure
A coworker asks you whether room air should be used with positive-pressure ventilation in the delivery room. Which answer is in agreement with the NRP recommendations?
resuscitation is started with 21% -30% oxygen and increase to 100% if you require chest compresions
When coordinating positive-pressure ventilation with chest compressions, approximately how many of each are performed each minute?
30 breaths, 90 compressions
Which of the following correctly describes the indications for chest compressions?
If the heart rate remains less than 60 beats per minute after 30 seconds of effective positive-pressure ventilation
Which of the following is a true statement about chest compressions?
Chest compressions circulate blood to the vital organs
Where is the appropriate position on this baby to apply chest compressions?
Sternum
You have been providing chest compressions and effective ventilation for 45-60 seconds. You check the heart rate and find a rate of 40 beats per minute. What should your next action(s) be?
Insert an umbilical catheter, administer epinephrine, and consider intubation
Which of the following is an appropriate depth to depress the sternum while performing cardiac compressions on a newborn baby?
To a depth of approximately one third of the anterior-posterior diameter of the chest.
Which of the following is a potential danger of administering chest compressions?
Fracturing ribs
What is the approximate time period within which one should ideally be able to intubate a newly born baby?
30 seconds
Which of the following is an indication for intubation?
Ineffective or prolonged bag-and-mask ventilation
Which of the following are correct steps when intubating a newborn?
Stabilize the baby’s head in the “sniffing” position, deliver free-flow oxygen during the procedure, and hold the laryngoscope in the left hand
Which of the following is an indication that the endotracheal tube is correctly placed in the trachea and not in the esophagus?
Increase heart rate
A pregnant woman undergoes an emergency C-section due to fetal distress after an automobile accident. The neona¬tologist is en route, but not present at the birth. You responds to the newborn code and determines that the newborn baby requires intubation to facilitate coordination with chest compressions but you make 2 failure attemps and the anestesiologist is working with the mother in hyovolemic schok . What should you made?
ventilate with bag and mask and colocate a orogastric tube
Which routes are used for administration of epinephrine, if needed during neonatal resuscitation?
- Intravenous
- Subcutaneous
- Endotracheal
- Intramuscular
1,3
Which of the following medications may be used during the first minutes of neonatal resuscitation?
Epinephrine
When is epinephrine indicated?
Persistent heart rate less than 60 beats per minute despite positive-pressure ventilation for 30 seconds followed by an additional 45 seconds of coordinated positive-pressure ventilation and chest compressions
The recommended route of administration of epinephrine is intravenously. When should intratracheally epinephrine via the endotracheal tube be considered ?
While the umbilical venous catheter is being placed
What are the appropriate doses of intravenous and intratracheally (via the endotracheal tube) epinephrine using a 1:10,000 concentration?
0.1 to 0.3 mL/kg Intravenously and 0.5 to I mL/kg intratracheally
You are ventilating a baby via an endotracheal tube and you suspect that medications and/or volume may be needed during this resuscitation. What should one member of the team begin to insert?
An umbilical venous catheter
Acceptable Solutions for volume expansion include which of the following
0.9% NaCl (normal saline); Ringer’s lactate
A newly born baby with a birth weight of 3.6 kg is responding poorly to your ongoing resuscitation efforts. There is a history of extensive vaginal bleeding, and the baby is pale. You decide to administer a volume expander, what is the amount that should be given?
36ml
While resuscitating a newborn, you suspect he has choanal atresia. What is one way of relieving the symptoms from this mechanical blockage of the airway?
Placement of an oral airway
A woman in a C-section received a barbituric for analgesia 5 minutes prior to delivery. Her baby has poor respiratory effort following birth. After suctioning, drying, and stimulation not improve the baby’s respiratory effort, what should you do next?
Begin positive-pressure ventilation
A newly born baby who has required resuscitation must have close monitoring and management of which of the following?
All of the above
You hear diminished breath sounds on the left side of the chest of a newborn with respiratory distress and note the newborn to have a flat (scaphoid) abdomen. What is the appropriate initial management of this newborn with suspected congenital diaphragmatic hernia?
Intubate the newborn and insert a large orogastric catheter
You are resuscitating a newborn that remains persistently bradycardic and cyanotic. What is the most likely reason for the persistence of these findings?
Inadequate ventilation
You note that a newborn with respiratory distress has a small mandible (jaw) and suspect she has the pharyngeal airway malformation known as the Pierre Robín (or Robín) syndrome. What actions will assist the baby to maintain an open airway?
Place the baby prone and insert a nasopharyngeal tube
Which of the following is a true statement about managing a newly born baby’s temperature during or following resuscitation?
Do not allow the baby to be overheated and become hyperthermic
You are called to the delivery of a newborn female with a birth weight of approximately 1,000 g and of 28 weeks’ gestation. What is a factor that places this baby at additional risk for requiring resuscitation?
Weak muscles and surfactant deficiency, making adequate ventilation more difficult
What additional resources are needed to prepare for a preterm birth?
AIl of the above
A baby is delivered at 29 weeks’ gestation. You initially started with 30% oxygen (0.30 FiO2). You have attached a pulse oximeter and, after 5 minutes, you note the oxygen saturation is 79% and not rising. You should do which of the following?
Increase the oxygen concentration
Which of the following procedures may decrease the risk of brain injury in a premature newborn during and after resuscitation?
Avoid excessive airway pressure
You recognize that premature newborns are vulnerable to hyperoxia and you have an oximeter and blender in your delivery room. What action is appropriate with this equipment during and immediately following resuscitation of babies born preterm?
After 5 to 10 minutes, attempt to maintain oxygen saturations in the 85% to 95% range
You are caring for a preterm newborn of 27 weeks’ gestation who is breathing spontaneously with a heart rate 170 beats per minute, but has labored respirations , o2 sat 79%,. Which of the following is the best action?
Administer nasal CPAP
You are called to attend an emergency C-section of a newborn male of 41 weeks’ gestation whose mother has apparently had an abruption of the placenta. The newborn has had continuous asystole (a heart rate of zero) from the time it was first assessed throughout the entire complete and adequate resuscitation. Following what duration of time might it be considerate to discontinue the resuscitative efforts?
10 min
Which statement describes appropriate ethical principle(s) regarding the resuscitation of a newly born baby?
The ethical principles should be no different from those of an older child or adult
You are called to the delivery of a newborn with 23 gestation weeks, weighing 385 g, a condition tassociated with almost certain early death and an extremely high morbidity rate among the rare survivors. Which action is appropriate?
Proporcionate only confort actions for the baby and mother
Who is (are) the usual and appropriate surrogate decision maker(s) for a newborn in most cases?
The parents
You are called to counsel parents of a fetus who is believed to be at the lower limits of viability and who will be delivered within the next hour. What advice should you give the parents concerning resuscitation decisions that are made prior to birth?
The decision may need to be modified depending on the condition of the baby at birth and the postnatal gestational age assessment
Which statement regarding withholding resuscitation and withdrawing support is true?
Withdrawal of support may be acceptable if there is agreement between the treating health care professionals and the parents that further efforts would be futile
You are discussing, with teenage parents, the uncertain prognosis of their baby about to be delivered at 23 weeks’ gestation. You tell them that survival is statistically unlikely at this gestation and that you anticipate a high rate of morbidity, should the baby survive. What should you do if the parents state that they either want you to resuscitate in all circumstances or if they ask you to do nothing?
The parents’ views on either initiating or withholding resuscitation should be supported
