Ventilation Technique

Question 1

What is done if you are unable to obtain physiologic improvement and adequate test movement with mask ventilation techniques?

Answer 1

Alternative airway such as endotracheal tube or a laryngeal mask airway if tubing is not possible

Question 2

What rate should you ventilate for positive pressure ventilation?

Answer 2

40 to 60 breaths per minute

Question 3

What is oxygen concentration changed to once chest compressions begin?

Answer 3

100% until the heart rate rises above 60 bpm and the cost oximeter is available and reliable, then oxygen concentration is adjusted to meet target saturation range indicated in the flow diagram

Question 4

If a newborn requires PPV for more than several minutes, what should be considered?

Answer 4

Placing and orogastric tube and leaving it in place

Question 5

What is required for orogastric tube insertion?

Answer 5

8F feeding tube
20 mL syringe
The links of tube to insert should be equal to the distance from the bridge of the nose to the earlobe and from the earlobe to a point halfway between the xyphoid process and the umbilicus.
Insert in mouth and leave the nose open for ventilation.
Syringe out quickly but gently the gastric contents.
Leave end of tube open to provide a vent for air entering the stomach

Question 6

For a flow inflating bag, The flow control valve needs to be adjusted so the bag is not over distended. Adjust the valves so that there is approximately how much each 20 pressure when the bank is not being squeezed? What is this equivalent to?

Answer 6

It should be 5 cm H2O and this is equivalent to PEEP

Question 7

What is the pressure at peak inflation for H2O and what is this equivalent to?

Answer 7

At firmly squeezing you are reaching the peak pressure and this should be around 30 to 40 cm H2O

Question 8

What does a test entail and what should be done if the bag does not fill wrap at the enough?

Answer 8

During the test the bag must be squeezed at a rate of 40 to 60 times per minute and a pressure of 40 cm H2O. If the bag does not feel rapidly enough, readjust the flow control valve or increase the gas flow from the flowmeter. Then, check to be sure that the pressure gauge still reads 5 cm H2O pressure of PEEP when the bag is not being squeezed. To avoid excessive PEEP, further adjustments may be necessary in the flow control valve

Question 9

What are the dials on a t piece resuscitator?

Answer 9

Maximum pressure relief control. The desired maximum pressure is set after occluding the peep and turning the maximum pressure belief control to the maximum pressure limit

Peak inspiratory pressure control is used to set the desired peak inspiratory pressure.

The circuit pressure gauge is used to set and monitor the peak inspiratory pressure, PEEP and maximum circuit pressure

The PEEP cap Is used to set the PEEp. When the PEEP valve is occluded by the operator, the preset peak inspiratory pressure is delivered to the patient for as long as the PEEP valve is occluded

Question 10

What should the maximum pressure belief control be set at?

Answer 10

10 mmHg higher than the maximum anticipated peak inspiratory pressure. Therefore it should be about 40 mmHg for term newborns and 30 mmHg for preterm newborns

Question 11

How to adjust the pressure settings for the t piece resuscitator?

Answer 11

1. Adjust the flow meter to regulate how much gas flows into the t piece resuscitator
2. Set the maximum circuit pressure by occluding the PEEP With your finger and adjusting the maximum pressure relief dial to a selected value, i.e. 40 cm H2O is maximum for term newborns and a lower for preterm newborn.
3. Set the desired peak inspiratory pressure by occluding the PEEP With your finger and adjusting the IP control to a selected pressure.
4. set the PeEP by removing your finger from the PeEP cap And adjusting the PEEP cap To the desired setting.
5. Remove the test long and attach the patient piece to eight facemask or be prepared to attach it to the endotracheal tube.

Question 12

Where does the PEEP fall within the breathe – 2–3 cadence?

Answer 12

The PEEP represents the 2 and 3 portions, while the breathe portion entails occluding the hole in the PEEP cap To allow higher pressure.

Question 13

How to deliver free flow oxygen through the t piece resuscitator?

Answer 13

Occlude the PEEP cap And hold the mask loosely on the face

Question 14

What are the ventilation corrective steps?

Answer 14

MR SOPA

Mask adjustment
Reposition airway
Suction mouth and nose
Open mouth
Pressure increase 
Airway alternative

Question 15

What are the estimated tip to lip distances based on baby weight?

Question 16

Where to listen post intubation?

Confirmatory?

Answer 16

Bilateral axillae

xray

Question 17

Endotrach tube sizes?

Answer 17

Wt.GA.           Tube 
25                    2.5
30.                   3.0
35.                   3.5
40                    4.0

Question 18

Endo tube sizes vs catheter size

Answer 18

2. 5 - 5F or 6F
3. 0 - 6F or 8F
4. 5 - 8F
5. 0 - 8F or 10F

Question 19

Laryngoscopes sizes?

Answer 19

No. 0 for preterm
No. 00 for very preterm
No. 1 for term newborns

Question 20

Where does the umbilical vein usually sit in the cord? Arteries?

Answer 20

Single 11 and 12 o clock.
Artery 4-8 o’clock

Cut 1-2 cm from belly

Question 21

How far?

Answer 21

Only til get blood, don’t want to risk hepatotox

Question 22

What is the appropriate concentration of Epi to use? Volume?

Answer 22

1: 10,000. 0.1-0.3 mL/kg in 1 mL syringe… Follow w 0.5-1 mL
(0. 5-1 mL/kg but only if endotracheal) in 3-6 mL syringe

Question 23

Dose of Ringers or 0.9 NaCl for volume resusc?

Answer 23

10 mL/kg via umbilical vein q5-10 min x 2. Longer if over 30 GA

Question 24

When to fluid resusc?

Answer 24

Baby is shocky… Pale colour weak pulse, persistently low hr, no improve despite resusc attempts.

Or

Hx of fetal blood loss.
Ie Extensive vag bleed, placenta preop, twin to twin transfusion