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PARA316- LIFESPAN HEALTH > WK4- Newborn Resuscitation > Flashcards

WK4- Newborn Resuscitation Flashcards

1
Q

What are the 2 key mechanisms that occur when a newborn takes their initial breath?

A

When a newborn takes their initial breaths this results in:
1- Absorption of the fluid that fills theirs lungs at birth
2- This absorption triggers an increase in pulmonary blood flow, oxygenating the patient

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2
Q

What are 5 risk factors this make newborns more likely to need resuscitation?

A

Babies who required resus were more likely to:
1- Have an APGAR score less than 7
2- Be of low birth weight
3- Be born pre-term
4- Be born as part of a multiple birth

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3
Q

‘Active Resuscitation’ for newborns incorporate 4 components. What are these?

A

Active Resuscitation:
1- Suctioning
2- Oxygenation
3- Ventilation
4- Compressions

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4
Q

“Many ambulance services recommend resuscitation is withheld in infants who are less than ___ weeks gestation”

A

Many ambulance services recommend resuscitation is withheld in infants who are less than 23 weeks gestation

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5
Q

What are the 4 key components of ‘The Golden Minute’ following birth?

A

The Golden Minute-
1- Drying
2- Warming
3- Airway Techniques
4- Stimulation

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6
Q

Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, what are indications the baby is Healthy?

A

Healthy Newborn RESPONSE:
1- Good muscle tone (not floppy)
2- Extremity flexion or active movement of limbs

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7
Q

Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, what are indications the baby is Compromised?

A

Compromised Newborn RESPONSE:
1- Poor muscle tone (floppy)
2- Minimal movement of limbs

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8
Q

Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, what are indications the baby is Healthy?

A

Healthy Newborn AIRWAY:
1- Clear, nil obstructions
2- No visible secretions in mouth/airway (eg. blood, meconium)

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9
Q

Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, what are indications the baby is Compromised?

A

Compromised Newborn AIRWAY:
1- Secretions (eg. blood, meconium) are obstructing the airway

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10
Q

Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, what are indications the baby is Healthy?

A

Healthy Newborn BREATHING:
1- Fast, regular respirations
2- Spo2 is within target range for duration after birth

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11
Q

Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, what are indications the baby is Compromised?

A

Compromised Newborn BREATHING:
1- Gasping or Apnoea
2- This Gasping/Apnoea is alongside HR <100 bpm

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12
Q

Newborn DRABCD Algorithm- When assessing a newborns CIRCULATION directly after birth, what are indications the baby is Healthy?

A

Healthy Newborn CIRCULATION:
1- HR >100bpm

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13
Q

Newborn DRABCD Algorithm- When assessing a newborns CIRCULATION directly after birth, what are indications the baby is Compromised?

A

Compromised Newborn CIRCULATION:
1- HR <100bpm

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14
Q

Newborn DRABCD Algorithm- When assessing a newborns RESPONSE directly after birth, you notice poor muscle tone (floppy) & minimal movement of the limbs. What INTERVENTION will you do?

A

Intervention-
1- Provide tactile stimulation by gently, but briskly, rubbing the newborn’s back, trunk or extremities with a towel
2- Rub abdomen up & down
3- Flick the underside of newborns feet

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15
Q

What must you NOT do when providing Tactile Stimulation to a newborn?

A

Do NOT- Slap, Squeeze or Shake the newborn

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16
Q

What is the RATIONALE for providing Tactile Stimulation to a newborn that has poor muscle tone (floppy) and minimal movement of their limbs?

A

Rationale for Tactile Stimulation-
a) Rouses the non-vigorous newborn
b) Stimulates breathing in an inadequately ventilating newborn
c) Warms newborn to aid maintenance of normothermia of newborn

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17
Q

Newborn DRABCD Algorithm- When assessing a newborns AIRWAY directly after birth, you notice secretions of blood and meconium obstructing the airway. What INTERVENTION will you do?

A

Interventions for obstructed airway-
1- Position baby supine with the head supported in a neutral position (avoiding flexion/extension of the neck). This position can be achieved by placing 2-5 cm of padding underneath the shoulders
2- Position newborn head on the side and gently wipe the mouth with edge of towel
3- IF suctioning is required (eg. obstruction is preventing newborn from breathing), the mouth should be suctioned first

18
Q

What is the RATIONALE for the neutral alignment of a newborns head during airway management?

A

RATIONALE for Neutral Alignment-
a) Newborns have a large occipital region (they have a large head, short neck, large tongue)
b) Newborns tracheal diameter is narrower and trachea is shorter, so flexion or hyperextension of neck can occlude airway

19
Q

What is the RATIONALE for clearing newborns airway by positioning their head on the side & using the edge of a towel as opposed to using suction?

A

RATIONALE for manual removal of obstructions-
a) Positional clearing of the airway is preferred over suctioning as suctioning does not remove liquid from lungs
b) Suctioning can cause vagal reactions leading to laryngeal spasm, bradycardia, & delay in onset time to spontaneous ventilation. It can also decrease oxygen saturation and increase infection risk

20
Q

IF Suctioning is required to clear a newborns obstructed airway…What is the RATIONALE for suctioning the mouth first (before the nose)?

A

RATIONALE for suctioning mouth first-
a) The newborn is a nasal breather and may gasp and inhale pharyngeal fluid if the nose is cleared first
b) This ensures that any blood in the pharynx is cleared and cannot be inhaled once the baby’s nostrils are clear

21
Q

Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, you notice that they are Gasping or Apnoeic. What is the other VITAL SIGN you want to check at this stage to determine your next course of action?

A

Check Heart Rate!
Why? Because if the newborn is gasping/apnoeic AND their HR is <100bpm then you will need to start resus efforts (IPPV using BVM)

22
Q

Newborn DRABCD Algorithm- When assessing a newborns BREATHING directly after birth, you notice they are gasping/apnoeic & their HR is <100bpm. What INTERVENTION will you do?

A

Interventions for Ineffective Breathing (Gasping/Apnoea) alongside HR <100bpm:
1- Ventilate newborn with BVM to supply IPPV (Intermittent Positive Pressure Ventilation)
1a- IPPV Rate= 40-60 breaths/min
1b- IPPV % Oxygen= Room Air
1c- IPPV Inspiratory Time= 0.5secs
1d- IPPV Duration= 30 secs before reassessment of HR

23
Q

Newborn DRABCD Algorithm- When ventilating a newborn with IPPV (Intermittent Positive Pressure Ventilation) ensure that:
a) IPPV Rate [ __ breaths/min]
b) % Oxygen
c) IPPV Inspiratory Time [ __ secs]
d) Duration before HR reassessment

A

Ventilation of newborn with BVM to supply IPPV (Intermittent Positive Pressure Ventilation)-
a) IPPV Rate= 40-60 breaths/min
b) % Oxygen= Room Air (21%)
c) IPPV Inspiratory Time= 0.5secs
d) IPPV Duration= 30 secs before reassessment of HR

24
Q

What is the VOLUME (mL) and TIDAL VOLUMES range (__mL- __mL) of a Newborn BVM?

A

Newborn BVM:
a) Volume= 240mL
b) Tidal Volumes= 10-35mL

25
Q

What are some signs paramedics can look for to ensure a good mask seal of the BVM on the newborns face?

A

Signs of good BVM Mask Seal-
1- Rise & fall of chest
2- Improved oxygen saturations
3- Improvements in HR

26
Q

What is the RATIONALE for using the BVM with Room Air (21% O2) & not attaching 100% O2 during the initial ventilation efforts?

A

RATIONALE for using Room Air (21% O2)-
1- High-flow oxygen concentrations can lead to free radical formation which is toxic to many tissues and organs in newborns.
2- Newborn babies, especially premature babies, can become rapidly and dangerously hyperoxic when exposed to 100% oxygen

27
Q

Newborn DRABCD Algorithm- After an initial 60 seconds of IPPV (room air) using the BVM, you reassess the newborn and find their HR is 60-100bpm. What INTERVENTION will you now do?

A

INTERVENTION for HR 60-100bpm after 60secs of IPPV (room air)-
1- Continue IPPV but attach Oxygen at 10L/min to supply 100% oxygen
2- Reassess every 30 seconds & a) Continue IPPV if HR 60-100, or
b) Start CPR if HR <60

28
Q

Newborn DRABCD Algorithm- After an initial 60 seconds of IPPV (room air) using the BVM, you reassess the newborn and find their HR is <60bpm. What INTERVENTION will you now do?

A

INTERVENTION for HR <60bpm after 60secs of initial IPPV (room air)-
1- Continue IPPV but attach Oxygen at 10L/min to supply 100% oxygen
2- Start CPR at a ratio of 3:1 [3 Compressions: 1 Ventilation]. Compression rate is 90 compressions/min, & 30 ventilations/min

29
Q

When doing CPR on a Newborn, what is the:
a) RATIO of Compressions to Ventilations
b) RATE of Compressions per min
c) RATE of Ventilations per min

A

Newborn CPR-
a) Ratio of 3:1 [3 Compressions: 1 Ventilation]
b) Rate of Compressions- 90 compressions/min
c) Rate of Ventilations- 30 ventilations/min

30
Q

During Newborn CPR, which part of the Sternum should chest compressions occur on?

A

Newborn CPR:
Chest Compressions should occur on the LOWER THIRD of the sternum

31
Q

During Newborn CPR, how often should you reassess heart rate?

A

Newborn CPR:
Reassess HR after every 30 second cycle

32
Q

During Newborn Resus, if CPR & IPPV (using BVM) are ineffective, what INTERVENTIONS should you consider next? [Hint- 1 is an airway adjunct, 3 are pharmacological]

A

If CPR & IPPV are ineffective consider:
1- Advanced Airway (LMA, ETT)
2- Adrenaline (10mcg/kg) every 4 min
3- Compound Sodium Lactate (10mL/kg bolus) if HR <60 despite adrenaline
4- Glucose 10% (2mL/kg) if BGL <2.6

33
Q

You have been doing CPR on the Newborn and following one of the reassessments (which occur every 30 secs), you determine the HR is 60-100bpm. What is your next step?

A

After a period of CPR, baby’s HR is 60-100bpm:
1- Stop chest compressions
2- Continue IPPV using the BVM with 10L/min O2, and 100% O2 delivery

34
Q

Although rare, should defibrillation be necessary on a newborn, what level of joules is used?

A

Newborn Defibrillation= 4 joules per kg

35
Q

Why is it rare for newborns to require defibrillation during resuscitation efforts?

A

Because the newborn heart is usually healthy and is beating with a normal rhythm

36
Q

What is the RATIONALE behind using an LMA (iGel) or ETT, and NOT an OPA during Newborn Resucitation?

A

ETTs & LMAs over OPAs for Newborns-
1- Limited evidence to support the use of OPAs in newborn resuscitation
2- OPAs can delay the onset of spontaneous respiration and can stimulate the vagus nerve, causing bradycardia

37
Q

What is the RATIONALE behind delaying cord cutting for Newborns?

A

Delayed Cord Cutting-
Why? Delayed cord cutting provides an increase in blood volume, red blood cells and iron to the newborn

38
Q

During all newborn resuscitation efforts, what two pieces of monitoring equipment should be utilised?

A

Monitoring equipment during Newborn Resus:
1- Pulse oximetry (on right hand/wrist, or right ear)
2- ECG monitoring

39
Q

You have been doing CPR on the Newborn and following one of the reassessments (which occur every 30 secs), you determine the HR is >100bpm. What is your next step?

A

After a period of CPR, baby’s HR is >100bpm:
Next Step= POST- RESUSCITATION SUPPORTIVE CARE
a) APGAR every 5 min until HR & RR normal
b) Maintain Normothermia (36.5-37.5)
c) Consider destination with NICU capabilities
d) Care for family

40
Q

After an initial 60 seconds of IPPV (room air) using the BVM, you reassess the newborn and find their HR is >100bpm. What is your next step?

A

After a period of IPPV, baby’s HR is >100bpm:
Next Step= POST- RESUSCITATION SUPPORTIVE CARE
a) APGAR every 5 min until HR & RR normal
b) Maintain Normothermia (36.5-37.5)
c) Consider destination with NICU capabilities
d) Care for family

41
Q

What is the RATIONALE behind maintaining Newborn Normothermia following birth & during any resuscitation efforts?

A

RATIONALE for maintaining Newborn Normothermia:
a) Newborns have less fat to draw on to create energy
b) Newborns have less fat to insulate the body
c) Newborns have a larger surface area relative to their size

42
Q

What are some methods paramedics can use to Maintain Normothermia in Newborns following birth & during resuscitation efforts?

A

Methods for Maintaining Newborn Normothermia:
1- Drying the baby
2- Skin-to-skin contact
3- Warm blankets
4- Covering head with beanie
5- Warm the external environment
6- If preterm (<28wks) Plastic wrap the baby

PARA316- LIFESPAN HEALTH (3 decks)

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