Resuscitation in the Delivery Room Flashcards
the fetal level of The partial pressure of oxygen (PO2) approximately…?
25 mm Hg
What is primary apnea …?.?
Fetuses initially respond to brief hypoxia by irregular respirations and apnea
What is secondary apnea…?
If the period of hypoxia continues, the fetus will irregularly gasp and lapse into secondary apnea
What is being central to resuscitation …?
establishing ventilation
Targeted preductal SpO2 after birth….?
1 minute. 60%–65%
2 minutes. 65%–70%
3 minutes 70%–75%
4 minutes 75%–80%
5 minutes 80%–85%
10 minutes 85%–95%
Suction catheter size for resuscitation ….?
Suction catheter 10 and 12 F and wall suction <100 mm Hg
While doing PPV flow rate of O2…?
Flow meter set at 10 L/minut
oxygen source and set blender in term and preterm ….?
room air for a term infant and
up to 30% for a preterm infant;
flow is set as per manufacturer’s recommendation for the T-piece resuscitator (10 L/minute)
T-piece resuscitator setting for PPV …?
positive end-expiratory pressure (PEEP) of 5 to 6 and
peak inspiratory pressure (PIP) of 20 to 25 mm Hg
laryngoscope size ….?
no. 1 for full-term neonates,
no. 0 for premature neonates,
no. 00 for extremely low-birth-weight neonates
ET tube for the expected birth weight …?
3.5 mm for fullterm infants,
3.0 mm for premature infants >1,250 g, and
2.5 mm for extreme preterm infants
Delayed cord clamping……?
If the infant is breathing spontaneously at birth, the cord should not be clamped and divided until at least 30 to 60 seconds have passed
Rapid assessment at birth……..?
■ Is the baby term?
■ Is the tone good?
■ Is the baby breathing or crying?
When to consider baby in secondary apnea….?
If breathing does not start after two attempts at tactile stimulation, the baby should be considered to be in secondary apnea
How to do Tactile stimulation …?
Tactile stimulation by tapping the sole or rubbing the back gently may help initiate breathing
Oxygen concentration should be increased to 100% during resuscitation when …?
if bradycardia (heart rate <60 bpm) does not improve after 90 seconds of resuscitation.
Indications for PPV are…..?
■ The infant is apneic/gasping despite tactile stimulation.
■ The infant has a heart rate of <100 bpm despite apparent respiratory effort.
Apnea with bradycardia represents what …..?
secondary apnea and
requires treatment with PPV
When indicated, PPV must be started within how many minutes ….?
1 minute of birth.
In infants with normal lungs, this inspiratory pressure is usually no more than…..?
15 to 20 cm H2O
The most important indicator of adequate ventilation is a….?
rise in the heart rate.
The first assessment after initiation of PPV should be at….
.?
15 seconds
What to do In case of poor chest rise at 15 seconds…..?
MRSOPA is used to optimize ventilation
MRSOPA….?
■ M—mask adjustment
■ R—reposition infant
■ S—suction airway
■ O—open airway
■ P—pressure to be increased
■ A—alternate airway (intubation)
What to after successfull PPV ….?
If the baby’s heart rate is >100/minute and he/she has good tone and respiratory efforts,
-one may decrease rates and pressure of PPV
-provide oxygen or CPAP for a while, and observe.
How to do intubation …?
the baby’s chin, sternum, and umbilicus are all lined up in a single plane and if, after insertion into the infant’s mouth, the laryngoscope handle and blade are aligned in that plane and lifted vertically at an approximately 60° angle to the baby’s chest, only one of four anatomic landmarks will be visible to the intubator
The depth of insertion of an ET tube is given by the formula …?
NTL + 1, where NTL denotes the nasotragal length
The nasotragal length is measured from the columella to the tragus
One must complete the intubation in within how many seconds …?
30 seconds
Laryngeal masks are easy to insert and are effective for ventilating newborns weighing…..?
> 2,000 g.
The best technique Chest compression ..?
The best technique is to encircle the chest with both hands, placing the thumbs together over the lower third of the sternum, with the fingers wrapped around and supporting the back.
Compress the sternum about one-third of the antero-posterior diameter of the chest
at a rate of 90 times per minute in a ratio of three compressions for each breath
After how many seconds of chest compression and PPV, briefly stop chest compression and check the heart rate
60 sec
When to consider for epinephrine …?
If no improvement is noted and the heart rate remains below 60 bpm, compression and ventilation should be continued. Epinephrine should be considered.
Indication for epinephrine …?
If the heart rate of the baby remains <60 bpm despite adequate ventilation with 100% oxygen (for 30 seconds) and chest compressions (60 seconds),
epinephrine (1:10,000, 0.1 mg/mL) should be given
The recommended dose of IV epinephrine…?
0.1 to 0.3 mL/kg (up to 1.0 mL) of a 1:10,000 epinephrine solution should ideally be given through the umbilical venous catheter and flushed with 3 mL normal saline into the central circulation
The intratracheal route of administration may be considered while IV access is being established, using doses of ..?
0.5 to 1.0 mL/kg of 1:10,000 dilution (0.05 to 0.10 mg/kg).
Combined Apgar …?
CPAP,
Oxygen,
Mask and Bag,
Intubation,
Neonatal chest compressions,
Exogenous surfactant, and
Drugs
Combined Apgar interpretation …?
Each intervention is scored 0 (if performed) and 1 (if not performed).
This is taken in combination with the above-specified Apgar score, and a score <10/17 is an indicator for high morbidity/mortality.
When to call newborn as vigorous, in MSAF …?
defined by strong respiratory effort,
good muscle tone, and a
heart rate >100 bpm
Delivery room resuscitation temperature ?..?
Set room temperature to 23°C to 25°C
When to consider for discontinuation of resuscitation ..?
If there are no signs of life in an infant after 10 to 20 minutes (2020 guidelines) of aggressive resuscitative efforts, with no evidence of correctible factors, discontinuation of resuscitation efforts may be considered
