Sept17 A1-neonatal_adaptation_resuscitation Flashcards
3 shunts in fetal circulation
- ductus arteriosus (pulm artery to aorta. bc lungs filled with fluid + non functional)
- foramen ovale (RA to LA)
- ductus venosus (shunts blood of left umb vein directly to IVC for O2 blood to skip the liver)
4 charact of fetal circulation
- alveoli are filled with fluid
- pulm arterioles constricted
- pulm blood flow diminished
- blood flow diverted across ductus arteriosus
how lungs start working at birth
- fluid replaced by 21% O2 air
- O2 leads to dilation of pulm vessels, constriction of ductus arteriosus and increased pulm blood flow
why BP increases at birth
clamping of umb cord leads to
- removal of low resist system (placenta)
- constriction of umb a and v
- increased systemic vascular resist (bc of hormones, etc.)
3 normal changes in the neonate circulation
- fluid in alveoli is absorbed
- increased systemic vascular resist
- increased pulm blood flow
first question in neonate circulation assessment
- term gestation?
- breathing, crying?
- good tone?
what if term, crying and good tone
ROUTINE care
- warmth (hat, blankets, radiant warmer, room temp above 25)
- clear airways (ONLY IF NECESSARY, suction bulb syringe or suction catheter, Mouth before Nose)
- dry with a linen sheet
- ongoing eval
what if premature or not breathing, crying or not good tone
- warm
- dry
- clear airways (ONLY IF NECESSARY)
- gentle stimulation (rub back, tap feet, etc.)
- reposition the airways (slightly extended neck). SNIFFING POSITION**
(MPORTANT) 2 imp questions after dry, clear airway, stim and warm in a premature or not breathing, crying or not good tone neonate
- HR below 100 bpm or baby gasping or apnea?
2. if no, labored breathing or persistent cyanosis?
most important vital sign in the baby
HR (bc SV doesn’t change much so HR determines CO)
what do you do if HR above 100 AND baby not labored breathing or persistent cyanosis
start positive pressure ventilation (PPV)
what if HR above 100 + spontaneous breathing BUT have respiratory distress and perceived cyanosis (baby looks blue)
- clear airways
- put baby on sat monitor (measures the O2)
- consided CPAP (continuous positive airway pressure)
signs of resp distress in the baby (thing you check with cyanosis after checking if HR<100 with gasping or apnea and answer is no)
- tachypnea (normal RR of baby is 40-60)
- intercostal or subcostal retractions
- nasal flaring
- tracheal tugging
- grunting
signs of persistent cyanosis in the baby (thing you check with resp distress after checking if HR<100 with gasping or apnea and answer is no)
central cyanosis (whole baby + lips and tongue and mouth are blue) *acrocyanosis (cyanosis of hands and feet with nice pink lips and tongue) IS NORMAL*
CPAP is used when
ONLY in babies with
- HR >100 and spontaneously breathing (no apnea)
- with labored breathing or persistent cyanosis
what to do in baby with HR below 100, or gasping or apnea
- PPV (positive P ventilation): provides 40-60 breaths per minute
- SPO2 monitoring
normal SPO2 sat in babies after birth
time after birth
- 1 min = 60%+
- 2 min = 65%+
- 3 min = 70%+
- 4 min = 75%+
- 5 min = 80%+
- 10 min = 85%+
when do you resuscitate a baby with more than 21% O2 ?
when SPO2 monitor shows values of SPO2 after birth too low for time after birth (like 50% at 1 min)
most important step in resuscitation
PPV (most babies recover after it = get back to HR>100 and no apnea)
diff devices for PPV
- flow inflating bag
- self-inflating bag
- T-piece resuscitator
first sign of improvement after PPV
improvement in HR
what do you do if HR still <100 after PPV
take ventilation corrective steps (MRSOPA)
- adjust Mask for good seal
- Reposition airway to sniffing position
- Suction mouth and nose secretions
- Open mouth slightly and move jaw forward
- increase Pressure to achieve chest rise (inflate lungs better)
- consider Airway alternative (endotracheal intubation or laryngeal mask airway)
what if HR is below 60 after ventilation corrective steps?
- intubate FIRST. AND NOW YOU USE 100% O2 NO MATTER WHAT
- start chest compressions
- need two people* (for PPV and compressions). coordinate both to not do them at the same time
- *3:1 compression to ventilation ratio**
what if HR still below 60 after PPV 100% O2 and compressions
give IV epinephrine.
best way to do it is umbilical venous line
what are some special resuscitation circumstances at birth
- meconium
- poor response to resuscitation
- prematurity
management of baby with meconium
- vigorous baby = normal resuscitation, dry, suction, stim
- non vigorous baby = follow the normal steps of resuscitation (1. premature, no tone or gasping. 2. HR<100 and apnea, and check cyanosis 3. HR<60 correctives 4. compressions and PPV. 5. IV epin)
normal neonate HR
140-160
causes of poor response to resuscitation
- hypovolemia airway (provide saline)
- malformation
- pneumothorax (needles to decompress)
- congenital diaphragmatic hernia (liver and small intestine in the chest)
- congenital heart disease
