Neonatal resuscitation

Question 1

In NRP, if the baby is not term, with poor tone, what is the first intervention (s) the provider should make?

Answer 1

• keep the baby warm
• Position airway
• Clear secretions if appropriate
• Dry/stimulate if 32 weeks

Question 2

How should a baby less than 32 weeks be kept warm?

Answer 2

-plastic bag

Question 3

After stimulating the baby, what is the next trigger point the NRP provider should take?

Answer 3

-Assess for apnea, gasping, and a HR of at least 100.

Question 4

If the heart rate is less than 100, what should the provider do in response?

Answer 4

-PPV, Spo2, monitor

Question 5

Post-Birth, how long should the initial phase of NRP last?

Answer 5

-1 Minute (Longer than one might think with a limp baby)

Question 6

Once PPV is initiated, how long should it last before escalation?

Answer 6

-15 seconds of good quality PPV

Question 7

What is MRSOP(P)A

Answer 7

-PPV technique and escalation strategy

-Mask adjustment
-Reposition Airway
-Suction
-Open mouth (OPA?)
-Pressure increase
(-Pressure increase PiP)
-Alternate airway ETT/SGA

Question 8

When does NRP request advanced airway insertion? before or after chest compressions?

Answer 8

-before CC

Question 9

After 15 seconds of PPV the HR is still less than 100, what do you do now?

Answer 9

• implement MRSOPA

- Provide high quality vents for 30 more seconds and re-assess HR.

Question 10

The HR is less than 60, what are the following interventions of NRP?

Answer 10

• ETI if not already done
• CPR, 3:1
• PPV continued, FIO2 100%
• ECG
• Emergency UVC

Question 11

How long should CPR go on for until HR examination?

Answer 11

-high quality 3:1 CPR should continue for 60 seconds before a pulse check.

Question 12

Neonatal HR is persistently less than 60 after each step of NRP, what is next?

Answer 12

• IV/IO Epi (0.01mg/kg IV)
• ET Epi (0.1mg/KG ETT)
• IV/IO/ETT epic given q3-5
• CPR for 60 more seconds until pulse check.

Proceed with this loop until HR exceeds 60bpm.

Question 13

What are the two trigger points of NRP?

Answer 13

• HR <100 first minute—>PPV

- HR <60 after PPV–>CPR+FIO2 100%

Question 14

What should the FIO2 be set at for initial PPV?

Answer 14

-21% RA

Question 15

What does the STABLE pneumonic stand for?

Answer 15

S-Sugar (2.6-6)
T-Temp (36.5-37.5)
A-Airway
B-Breathing 
L-Labs (CO2 35-45)
E-Emotional Support/Debrief

Prepare for transport/notification

Question 16

What is the timing for NRP escalation?

Answer 16

• 15 seconds of PPV then check HR, then MRSOPA
• Good vents for 30 seconds then check HR
• CPR 3:1 for 60 seconds then HR check.

Question 17

What is the DOPE pneumonic?

Answer 17

D-Displacment
O-obstruction
P-Pneumothorax
E-equipment failure