Sept17 A1-neonatal_adaptation_resuscitation

Question 1

3 shunts in fetal circulation

Answer 1

• 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)

Question 2

4 charact of fetal circulation

Answer 2

• alveoli are filled with fluid
• pulm arterioles constricted
• pulm blood flow diminished
• blood flow diverted across ductus arteriosus

Question 3

how lungs start working at birth

Answer 3

• fluid replaced by 21% O2 air

- O2 leads to dilation of pulm vessels, constriction of ductus arteriosus and increased pulm blood flow

Question 4

why BP increases at birth

Answer 4

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.)

Question 5

3 normal changes in the neonate circulation

Answer 5

• fluid in alveoli is absorbed
• increased systemic vascular resist
• increased pulm blood flow

Question 6

first question in neonate circulation assessment

Answer 6

• term gestation?
• breathing, crying?
• good tone?

Question 7

what if term, crying and good tone

Answer 7

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

Question 8

what if premature or not breathing, crying or not good tone

Answer 8

• warm
• dry
• clear airways (ONLY IF NECESSARY)
• gentle stimulation (rub back, tap feet, etc.)
• reposition the airways (slightly extended neck). SNIFFING POSITION**

Question 9

(MPORTANT) 2 imp questions after dry, clear airway, stim and warm in a premature or not breathing, crying or not good tone neonate

Answer 9

1. HR below 100 bpm or baby gasping or apnea?

2. if no, labored breathing or persistent cyanosis?

Question 10

most important vital sign in the baby

Answer 10

HR (bc SV doesn’t change much so HR determines CO)

Question 11

what do you do if HR above 100 AND baby not labored breathing or persistent cyanosis

Answer 11

start positive pressure ventilation (PPV)

Question 12

what if HR above 100 + spontaneous breathing BUT have respiratory distress and perceived cyanosis (baby looks blue)

Answer 12

• clear airways
• put baby on sat monitor (measures the O2)
• consided CPAP (continuous positive airway pressure)

Question 13

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)

Answer 13

• tachypnea (normal RR of baby is 40-60)
• intercostal or subcostal retractions
• nasal flaring
• tracheal tugging
• grunting

Question 14

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)

Answer 14

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*

Question 15

CPAP is used when

Answer 15

ONLY in babies with

• HR >100 and spontaneously breathing (no apnea)
• with labored breathing or persistent cyanosis

Question 16

what to do in baby with HR below 100, or gasping or apnea

Answer 16

• PPV (positive P ventilation): provides 40-60 breaths per minute
• SPO2 monitoring

Question 17

normal SPO2 sat in babies after birth

Answer 17

time after birth

• 1 min = 60%+
• 2 min = 65%+
• 3 min = 70%+
• 4 min = 75%+
• 5 min = 80%+
• 10 min = 85%+

Question 18

when do you resuscitate a baby with more than 21% O2 ?

Answer 18

when SPO2 monitor shows values of SPO2 after birth too low for time after birth (like 50% at 1 min)

Question 19

most important step in resuscitation

Answer 19

PPV (most babies recover after it = get back to HR>100 and no apnea)

Question 20

diff devices for PPV

Answer 20

• flow inflating bag
• self-inflating bag
• T-piece resuscitator

Question 21

first sign of improvement after PPV

Answer 21

improvement in HR

Question 22

what do you do if HR still <100 after PPV

Answer 22

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)

Question 23

what if HR is below 60 after ventilation corrective steps?

Answer 23

• 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**

Question 24

what if HR still below 60 after PPV 100% O2 and compressions

Answer 24

give IV epinephrine.

best way to do it is umbilical venous line

Question 25

what are some special resuscitation circumstances at birth

Answer 25

• meconium
• poor response to resuscitation
• prematurity

Question 26

management of baby with meconium

Answer 26

• 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)

Question 27

normal neonate HR

Answer 27

140-160

Question 28

causes of poor response to resuscitation

Answer 28

• hypovolemia airway (provide saline)
• malformation
• pneumothorax (needles to decompress)
• congenital diaphragmatic hernia (liver and small intestine in the chest)
• congenital heart disease