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PAR3031 - MATERNITY > Week 11 > Flashcards

Week 11 Flashcards

1
Q

what are the S&S of a healthy newborn?

A
  • Cry vigorously
  • Have a heart rate over 100 bpm within a minute after birth
  • Be fully flexed: both arms and legs
  • Become centrally pink by 7-10 minutes of age
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2
Q

When do you use suction on a newborn?

A
  • Vigorous newborns do not require suctioning
  • Only suction if obvious blood or meconium
  • obstructing the airway: mouth then nose
  • Use 10Fg or 12Fg catheter
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3
Q

What are some considerations for suctioning a newborn?

A
  • Suctioning can cause complications:
  • Delayed onset of effective breathing
  • Laryngospasm & bradycardia
  • Trauma to soft tissues
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4
Q

What is often able to stimulate breathing in a newborn?

A

Drying them

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5
Q

According to AV CPG’s ‘The Newborn Baby’, what steps do you take if the newborn is breathing adequately and has good muscle tone after delivery?

A
  • continue to dry (especially the head)
  • maintain warmth (skin to skin, blanket, hats)
  • Routine suction is not recommended
  • Monitor HR (ausciltation), breathing, tone and colour
  • If Vital signs deteriorate or airway obstructed manage as per Newborn Resus.
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6
Q

According to AV CPG’s ‘The Newborn Baby’, what steps do you take if the newborn is breathing adequately and has good muscle tone after delivery AND DOES NOT REQUIRE RESUS?

A

Cut cord once it’s stopped pulsing (approx 1-2mins) unless parental preference is to have it remain attached.

  • note APGAR score
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7
Q

According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is Over 36 weeks gestation, uncomplicated and stable?

A

Tx to appropriate maternity service (pre-booked hospital)

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8
Q

According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is 32-36 weeks AND stable VSS?

A

Tx to a level 2 hospital (paediatrician and midwife on site 24/7) in consultation with PIPER

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9
Q

According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if the baby is under 32 weeks OR unstable VSS?

A

Tx to tertiary centre in consultation with PIPER

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10
Q

According to AV CPG’s ‘The Newborn Baby’, what are the transport recommendations if you are Rural?

A

Tx to nearest base hospital or hospital with maternity service and contact PIPER

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11
Q

What are the steps to Newborn resus in the AV CPGs?

A

After birth, being dried and skin to skin with mother:

    • > assess breathing & muscle tone

2.
IF Apnoeic or gasping OR no muscle tone:
- stimulate by drying (not more than 30 seconds)
- Maintain warmth
- Placesupine with head/neck in neutral position
- suction only if airway obstruction is suspected

3.
-> re-assess breathing & muscle tone

4. 
IF HR<100 and/or apnoeic or gasping:
- IPPV @ 40-60 per minute on room air
- Pulse oximetry (right hand or right wrist)
- ECG monitoring
- reassess after 30 seconds

5.
-> re-assess breathing & muscle tone

  1. IF HR <60:
    - CPR 3:1 ratio with oxygen (5L/min)
    - Consult PIPER for all infants with HR<60

IF HR 60-100:

  • IPPV @40-60bpm
  • ensure adequate mask seal, airway position and increase ventilation pressure targeting chest riuse
  • If no increase in HR then IPPV with o2 5L/min

IF HR>100 but o2<90:
Breathing laboured
- IPPV @40-60
Titrate o2 (1-5L/min) to meet target spo2

Breathing normally

  • Maintain warmth and treat as newborn baby
  • titrate o2 (1-2L/min) via nasal cannula to meet target sats
  • discontinue o2 when spo2 >90%
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12
Q

What do you do in neborn resus if the HR<60 after stimulation and IPPV 40-60 for 30 seconds?

A

IF HR <60:

  • CPR 3:1 ratio with oxygen (5L/min)
  • Consult PIPER for all infants with HR<60
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13
Q

What do you do in neborn resus if the HR = 60-100 after stimulation and IPPV 40-60 for 30 seconds?

A

IF HR 60-100:

  • IPPV @40-60bpm
  • ensure adequate mask seal, airway position and increase ventilation pressure targeting chest riuse
  • If no increase in HR then IPPV with o2 5L/min
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14
Q

What do you do in neborn resus if the IF HR>100 but o2<90 after stimulation and IPPV 40-60 for 30 seconds?

A

IF HR>100 but o2<90:
Breathing laboured
- IPPV @40-60
Titrate o2 (1-5L/min) to meet target spo2

Breathing normally

  • Maintain warmth and treat as newborn baby
  • titrate o2 (1-2L/min) via nasal cannula to meet target sats
  • discontinue o2 when spo2 >90%
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15
Q

What are the steps for airway management in newborn resus

A
  • Head in neutral or slightly extended position
  • Padding may be required under shoulders
  • Normally newborns do not require suctioning at birth. Suctioning can delay normal rise in oxygenation
  • Suctioning should not be used except when babies show obvious signs of obstruction to either spontaneous respirations or IPPV
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16
Q

How d you suction a newborn?

A

Suction mouth first –then nose where needed. Use a soft 10 -12g catheter with <100mmHg pressure (AV guidelines)

17
Q

How should a face mask be applied to a newborn?

A

Face mask should be applied using rolling motion from chin to nose bridge and held in place to ensure there are minimal leaks

18
Q

What is the most important part of using a mask for a newborn?

A

Correct and adequate seal is imperative, it is therefore important to have a range of sizes available

19
Q

what size LMA do you use for a neonate?

A

• Size 1 LMA / SGA for up to 5kg neonate

20
Q

How can you confirm effective ventilations in IPPV?

A

Effectiveness of ventilations can be confirmed by observing:

  1. Increase in heart rate above 100/min
  2. A slight rise of the chest and upper abdomen with each inflation
  3. Oxygenation improves
21
Q

When are chest compressions indicated for newborn resus?

A

Chest compressions are indicated when the heart rate is <60 despite adequate assisted ventilation provided for 30 seconds.

22
Q

Why do you monitor spo2 on neonate right hand or arm?

A

to ensure SpO2 reading is pre-ductal (hand or wrist)

•Left hand and other body part may be influenced by the ductus arteriosus

23
Q

What are the target saturation levels in neonatal resus after 1 minute?

A

60-70

24
Q

What are the target saturation levels in neonatal resus after 2 minutes?

A

65-85

25
Q

What are the target saturation levels in neonatal resus after 3 minutes?

A

70-90

26
Q

What are the target saturation levels in neonatal resus after 4 minutes?

A

75-90

27
Q

What are the target saturation levels in neonatal resus after 5 minutes?

A

80-90

28
Q

What are the target saturation levels in neonatal resus after 10 minutes?

A

85-90

29
Q

What do you do if baby is preterm (<32 weeks) or under 1500 grams?

A
  • Increase environmental temperature
  • Place in polyethylene plastic zip lock bag
  • Put baby’s entire body in the bag (head out)
  • Dry and cover the head (except the face) with a woollenhat or folded towel/blanket.
  • Zip-lock the bag at the bottom (feet end) so the body is contained in the bag.
  • Provide warmth around the bag (skin-to-skin with mother or warm towels).
30
Q

What is the preverref IV access site in neonates?

A

umbillical vein

31
Q

What are the benefits to intraosseous access?

A

• Provides a non-collapsible point of drug
entry.

  • Peak plasma levels in 80-110 seconds versus 60-80 in central venous access
  • Various locations, includes: proximal and distal tibia, humoral head and lower femur in paeds
32
Q

What are the tertiary hospitals for maternity and neonate in Vic?

A

Tertiary centre (Metro births) –Consult PIPER
• Mercy, Monash, Women’s and RCH
- All infants <32 weeks’ gestation
- All intubated infants
- Level 2 public maternity hospital (Neonates >32 weeks and <37 weeks)

33
Q

What is sudden unexpected death in infancy (SUDI)?

A

SUDIincludes:
• SIDS
• Other sudden death cause unknown (autopsy performed)
• Other ill defined and unspecified causes of mortality (no autopsy performed)
• Suffocation whilst sleeping (including asphyxiation by bedclothes and overlaying)
• Intentional child death
• Causes are undetermined

34
Q

Define SIDS?

A

The sudden and unexpected death of an infant under 1 year of age, with onset of the lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy, and review of the circumstances of death and the clinical history

35
Q

WHat are some inherent SIDS risk factors

A
  • Under 12 months
  • 3-6 months
  • Male
  • Prematurity
  • Multiple birth
  • LBW
  • Cold/infection
36
Q

WHat are some PREVENTABLE SIDS risk factors

A
  • Tummy/side sleeping
  • Head covered
  • Over heating
  • Smoking
  • CO2re-breathing
  • Formula feeding
37
Q

What is the ambulance response for SIDS?

A

The SIDS protocol ensures that;
• Parents are allowed to carry baby to ambulance and travel with them to hospital once police have finished their investigations

Infant and parents are transported to Emergency Department of :
• Royal Children’s Hospital,
• Monash Medical Centre,
• Frankston Hospital or,
• in country areas, nearest base hospital

38
Q

What are some key points for paramedics responding to SIDS?

A
  • Take time
  • Slow down the process of events
  • Involve Family members at all stages during the emergency period.
  • Be aware of cultural differences
  • Encourage them to see, touch and hold their child.
  • Include the other children
  • Offer Information
  • Keep the family informed about what’s happening, and what happens next.
39
Q

What is the police role n SUDI cases?

A
  • Police are required to attend all SUDI, and have a legal mandate to act as a representative of the coroner
  • Requirement to attend all sudden deaths
  • Depending on circumstances, may notify other sections of the Victorian Police. Eg. Accident Investigation Section, Homicide, Arson Squad
  • Support family
  • Offer to telephone another family member, friend or doctor
  • Offer information about what happens next
  • Complete the appropriate forms (service dependent)
  • Notify Coroner

PAR3031 - MATERNITY (11 decks)

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