Week 11 - neonatal resus

Question 1

how do we want the airway positioned?

Answer 1

head in numeral or slightly extended position

Question 2

how do we suction the neonates airway?

Answer 2

only suction if obvious blood or meconium
obstruction mouth then nose
use soft 10-12mm catheter with no more than 100mmhg pressure

Question 3

what are some of the complications of suctioning a neonates airway?

Answer 3

delayed onset of effective breathing
laryngospams and bradycardia
trauma to soft tissue

Question 4

what are some suctioning considerations?

Answer 4

don’t suction before birth of shoulders

don’t suction if crying/vigorous

Question 5

what do we do with the BVM for a newborn resus?

Answer 5

drying the infant offend suffienct to stimulate breathing
no shaking, slapping, flicking

if the newborn does not start breathing start BVM

Question 6

how are ventilations performed for a neonatal resus?

Answer 6

initial ventilation about clearing the lungs
may require higher airway pressure

ventilations provided at 40-60 per minute uw and an inspiritry time of 0.3-0.5 seconds

if after 30 seconds HR <100 then 100% O2 on 5L/min

Question 7

how do we know if resus/breathing is effective?

Answer 7

increase of HR to over 100
rise and fall of chest
oxygenation of neonate improve

Question 8

when do compression need to occur?

Answer 8

when HR is <60 despite 30 seconds of breaths

Question 9

what is the compression ratio for newborn resus

Answer 9

3 to one compressions to 1 ventilation

Question 10

what are the target SPO2 readings of the neonate?

Answer 10

1 min 60-70
2 min 65-85
3 min 70-90
4 mins 75-90
5 mins 80-90
6 mins 85-90

Question 11

where should the SPO2 prob be placed on a neonate?

Answer 11

right hand or wrist not left due to the influence of the ductus arterioles on the left side not giving an accurate reading

Question 12

what are the receiving hospitals for neonates?

Answer 12

mercy, Monash, womens and RCH - infants < 32 weeks, intubated

level 2 public maternity hospital neonates >32 weeks and <37 weeks

Question 13

what is SIDS?

Answer 13

the sudden and unexpected death of an infant under the age on one year old

Question 14

what are the inherent risk factors for SIDS?

Answer 14

inherent 
under 12 months 
3-6 months
male 
prematurity
multiple birth 
LBW
cold/infection

Question 15

what are the preventative risk factors for SIDS?

Answer 15

tummy/side sleeping
over covered
over heating
smoking
CO2 re-breathing 
formula feeding

Question 16

what make up 86% of infant deaths in australia?

Answer 16

perinatal conditions 53% complications of the chord, placenta nd membranes, maternal complications of pregnancy
congenital abnormalities 23%
symptoms and signs of abnormal findings, including sudden infant death syndrome 9.3%

Question 17

what percentage of babies die from SIDS?

Answer 17

3% death of all infants

Question 18

what is SUDI?

Answer 18

covers previous SIDS and other fatal sleep accidents
- suffocation while sleeping
inertial child death
causes undetermined

Question 19

what accounts for the majority of SUDI?

Answer 19

unsafe sleeping environments account for over 90% of SUDIs
- to prevent serious sleep accidents
safe cot
safe mattress and safe bedding

Question 20

what to do after SUDI?

Answer 20

police must be notified - unexpected death 
support family
offer telephone family
offer information on what happens next 
complete prorate forms 
notify coroner

Question 20

what to do after SUDI?

Answer 20

police must be notified - unexpected death 
support family
offer telephone family
offer information on what happens next 
complete prorate forms 
notify coroner

Question 21

where should compressions on a newborn be perfomed?

Answer 21

lower third of the sternum

Question 22

what can MICA do in a neonatal resus?

Answer 22

intubate
adranalin 10mcg/kg IV 4 minutley
if HR <60 despite adranlain and ventialtions then normal saline 10-20ml/kg repate if necissary

Question 23

what is the preefered acess site in neonatal resus?

Answer 23

umbilicle vein- IV acess difficult

Question 24

what are some extra things to do with a pre-term or <1500g nenoate?

Answer 24

increase tempreture
place in ziplock bag - dry and cover heds
provide warmth

Question 25

what apgar score and when in a baby greater than 34 weeks be suggestive of poor outcome?

Answer 25

1-3 after 20 minutes ut with a detectable HR

Question 26

what does the neumonic mr sopa stand for and assist us with?

Answer 26

adeqaute ventilations in nonatal resus

mask- check fit and size
reposition0 aligne head/neck nutral
s- suction airway- patency
Open mouth  by lifting jaw
Pressure increases 
Alternative airway- adjucts an intubation