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NNP I > DR Resus WK2 > Flashcards

DR Resus WK2 Flashcards

(101 cards)

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1
Q

Resuscitation: Incidence

  • all births
  • PPV
  • ETT
  • chest compressions
A
  • 6-10% some degree
  • 5% PPV
  • 2% ETT
  • .1% chest compressions
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2
Q

Resuscitation: Risk Factors (Moderate Risk)

A
  • 34-27wk
  • 2-2.5kg
  • IUGR
  • fetal anemia/isoimmunization
  • polyhydramnios
  • GDM
  • prolapse cord
  • chorio/maternal fever
  • general anesthesia
  • stat c/s
  • intrapartum hemorrhage
  • abruption
  • MSAF
  • abnormal FHR tracing
  • instrumented delivery
  • breech
  • shoulder dystocia
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3
Q

Resuscitation: Risk Factors (High Risk)

A
  • <34wk
  • <2kg
  • fetal hydrops
  • major fetal anomalies that compromise respiratory transition
  • fetal bradycardia
  • acute or severe complication labor
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4
Q

NRP: Questions to Ask (4 + optional)

A
  • GA
  • Fluid - clear, meconium, blood
  • DCC
  • Risk factors
  • If time
    • FHR tracing
    • estimated weight (PT, NICU admin suspected)
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5
Q

SOBPIE: Meaning

A
  • Situation
  • Opinions
  • Basic manners
  • Parents
  • Info
  • Emotions
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6
Q

Shared Mental Model: Definition

A
  • perception, knowledge, understanding situation shared by team through communication
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7
Q

Types of Briefing

A
  • Pre brief - prior to delivery
  • Recap - during resuscitation
  • Debrief - reviewing resuscitation
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8
Q

Why to Debrief

A
  • improve pt outcomes
  • Identify training needs
  • Identify process failures
  • Improve morale
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9
Q

DCC Effects at 2yr

A
  • decrease death at 2yr
  • similar rate morbidity
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10
Q

Resuscitation: Prepartum Risk Factors

A
  • <36wk
  • >41wk
  • PE
  • Multiple gestation
  • Fetal anemia
  • Polyhydramnios
  • Oligohydramnios
  • Hydrops
  • LGA
  • IUGR
  • Malformations
  • No PNC
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11
Q

Resuscitation: Intrapartum Risk Factors

A
  • Stat c/s
  • Instrumented
  • breech/abnormal position
  • FHR category II or III
  • General anesthesia
  • Mag sulfate
  • Abruption
  • Intrapartum bleeding
  • Chorio
  • <4hr opioids
  • Shoulder dystocia
  • MSAF
  • Prolapsed cord
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12
Q

FHR: wnl

A

110-160bpm

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13
Q

FHR: Tachycardia

A
  • >160
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14
Q

FHR: Tachycardia Etiology

A
  • Infection
  • Hypoxia
  • Maternal drugs
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15
Q

FHR: Bradycardia

A

<110

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16
Q

FHR: Bradycardia Etiology

A
  • Hypoxia
  • Complete heart block
  • Maternal drugs (BB)
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17
Q

Accelerations: Indicate

A
  • Fetal movement
  • Indicator fetal well being
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18
Q

Decelerations: Types

A
  • Early
  • Late
  • Variable
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19
Q

Decelerations: Early Patho

A
  • Wnl
  • Head compression
  • Mirror image contraction
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20
Q

Decelerations: Late Etiology

A
  • Uteroplacental insufficiency
  • Fetal hypoxia
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21
Q

Decelerations: Late Definition

A

Nadir after contraction peaks

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22
Q

Decelerations: Variable Definition

A

V or W w rapid return to baseline

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23
Q

Decelerations: Variable Etiology

A
  • Abrupt compression cord
  • Oligohydramnios
  • Benign
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24
Q

Variability: Patho

A
  • Rapid fluctuations
  • Most sensitive indicator fetal well being
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25
Variability: Wnl
6-25 moderate
26
Variability: Decreased Types
* Minimal - \<5 * Absent - undetectable
27
Variability: Decreased Etiology
* Severe hypoxia * Anencephaly * Maternal narcotics * Magnesium * Wnl fetal sleep cycle
28
FHR: Categories
* I * II * III
29
FHR: Category I Definition
* Baseline rate 110-160 * Moderate variability 6-25 * NO late or variable decels * Accelerations present
30
FHR: Category II Definition
* NOT category I or III * Most common
31
FHR: Category III Definition
* Sinusoidal pattern * Bradycardia * Absent variability * Decelerations * Recurrent late * Recurrent variable
32
Resuscitation: Maternal Hx Risk Factors and MGMT
* Hemorrhage - volume expansion * Decrease FHR - prolonged resuscitation, hypothermic tx * Extreme PT - plastic wrap, thermal hat, decrease noise, light, positioning
33
NRP: Equpiment
* Radiant warmer * Blanket towels * Bag and mask * Rate 5-8L * 20-25/5 * max 30 PT, 40 FT/5 * Stethoscope * Bulb suction * ETT w laryngoscope * O2 * Rate 10L * FiO2 21-30% * Suction * 80-100mmHg * 10-12F catheter * Drugs and fluids * Syringes, needles, cannulas, IV lines, catheters * Meconium aspirator
33
NRP: Equipment
* Radiant warmer * Blanket towels * Bag and mask * Rate 5-8L * 20-25/5 * max 30 PT, 40 FT/5 * Stethoscope * Bulb suction * ETT w laryngoscope * O2 * Rate 10L * FiO2 21-30% * Suction * 80-100mmHg * 10-12F catheter * Drugs and fluids * Syringes, needles, cannulas, IV lines, catheters * Meconium aspirator
34
Fetal Asphyxia: Types
* 1ary * 2ary treat every DR apnea as 2ary bc CANT know
35
Fetal Asphyxia: 1ary Apnea s/s
* Apneic * Cyanosis * Increase HR * Easy resuscitation (dry, suction, stim)
36
Fetal Asphyxia: 2ary Apnea s/s
* Apneic * Pallor * Floppy * Decrease HR * Decrease BP * Active resuscitation
37
NRP Steps: 1st 30s
* rapid assessment * warm, dry, stim * sniffing position * clear airway * additional tactile stim 5-10s * supp O2 by 30s
38
NRP: Rapid Assessment 1st 30s
* FT * Good tone * Breathing or crying
39
NRP: Clear Airway Types and Methods
* Bulb section preferred * Consider not using suction catheter until \>5min life rt risk vagal (bradycardia) * suction canister * Mouth then nose * NOT \>5cm deep * NOT \>5s
40
NRP: Supp O2 Types
* Blow by * CPAP * PPV
41
NRP: Supp O2 Indications
* Cyanosis * Respiratory distress
42
NRP: Supp O2 if breathing Types
* W cyanosis - blow by O2 5-8L/min * W respiratory distress - CPAP
43
NRP: w apnea or gasping Types
* PPV * ETT * LMA
44
NRP: Target SpO2 * 1min * 2min * 3min * 4min * 5min * 10min
* 1min - 60-65% * 2min - 65-70% * 3min - 70-75% * 4min - 75-80% * 5min - 80-85% * 10min - 85-95%
45
NRP: PPV Indications (3)
* If remain apneic or gasping * HR \<100 * Persistent central cyanosis despite FiO2 100%
46
NRP: PPV Contraindcations
CDH
47
NRP: PPV Rate
* 40-60bpm
48
NRP: PPV Bag flow
5-8L
49
NRP: PPV Starting FiO2
* \>35wk 21% * \<35wk 21-30%
50
NRP: PPV Pressure * 1st breath * wnl lungs * decrease compliance * max
* 1st breath - 30-40cmH2O * wnl lungs - 15-20cmH2O * decrease compliance - 20-40cmH2O * max * FT - 40cmH2O * PT - 30cmH2O
51
NRP: PPV When should you notice chest rise?
* 4-5th breath * NOT abdomen
52
NRP: MR. SOPA
* Mask adjust * Repositioning baby (sniffing) * PPV * Suction mouth and nose * Open mouth and lift jaw forward * PPV * Pressure increase every few breaths until chest wall movement * PPV * Artificial airway (ETT, LMA)
53
NRP: What to do with NO chest movement or HR\<60 despite adequate ventilation
* alternate airway
54
NRP: ETT Indciations
* NO chest movement PPV * NO increase HR PPV * CDH congenital diaphragmatic hernia (NO PPV)
55
NRP: ETT Landmarks
* tongue * epiglottis * vocal cords → trachea/glottis * esophagus
56
NRP: s/s misplaced ETT
* Increase size stomach (esophagus) * Breath sounds louder over stomach (esophagus) * Decrease breath sounds L side (R mainstem) * NO improvement HR or color
57
NRP: ETT Insertion Depth what GA or weight 5.5cm
* GA 23-24wk * wt 500-600
58
NRP: ETT Insertion Depth what GA or weight 6.0cm
GA 25-26wk wt - 700-800
59
NRP: ETT Insertion Depth what GA or weight 6.5cm
GA 27-29wk wt 900-1,000
60
NRP: ETT Insertion Depth what GA or weight 7.0cm
GA 30-32 wt 1,100-1,400
61
NRP: ETT Insertion Depth what GA or weight 7.5cm
GA 33-34wk wt 1,500-1,800
62
NRP: ETT Insertion Depth what GA or weight 8.0cm
GA 35-37wk wt 1,900-2,400
63
NRP: ETT Insertion Depth what GA or weight 8.5cm
GA 38-40 wt 2,500-3,100
64
NRP: ETT Insertion Depth what GA or weight 9.0cm
GA 41-43wk wt 3,200-4,200
65
NRP: Indications LMA
* Airway malformation * Inability place ETT
66
NRP: Chest Compressions Indications
* HR\<60 w adequate ventilation
67
NRP: Chest Compressions How To
* Thumbs lower ½ sternum (below nipples) * ⅓ AP diameter * 120/min * 3:1 compression:ventilation * 100% FiO2 * Ideally, NOT leader (leader oversee)
68
NRP: Epinephrine Indications
HR\<60 w 60s chest compressions
69
NRP: Epinephrine MOA
* Peripheral vasoconstriction * Increase cardiac contractility * Increase HR
70
NRP: Epinephrine Concentration
1mg/10ml (0.1mg/ml)
71
NRP: Epinephrine Dose
* TT 1ml/kg (0.1mg/kg) * Several ETT breaths * IV/IO 0.2ml/kg (0.2mg/kg) * Flush 3ml NS * Do NOT wait 3-5min for IV dose s/p ETT (give ASAP) * Q3-5min
72
NRP: Epinephrine When to Assess s/p dose
60s s/p dose
73
NRP: Volume Expander Indications
HR\<60 AND evidence volume loss
74
NRP: Volume Expander Dose
IV/IO 10ml/kg / 5-10min
75
NRP: Volume Expander Types
* NS * Lactated ringers * Uncrossmatched O- whole blood
76
APGAR: What does it measure
* HR * Respiratory Effort * Muscle Tone * Reflex (to pain) * Color
77
APGAR: HR Points
* 0 - absent * 1 - HR\<100 * 2 - HR\>100
78
APGAR: Respiratory Effort Points
* 0 - Absent * 1 - slow, irregular * 2 - good, crying
79
APGAR: Muscle Tone Points
* 0 - limp * 1 - some flexion * 2 - active motion
80
APGAR: Reflex to stim Points
* 0 - No response to stim * 1 - grimace * 2 - cough, sneeze
81
APGAR: Color Points
* 0 - blue, pale * 1 - body pink, extremities blue * 2 - completely pink
82
DR ER: PT Complications
* hypothermia * respiratory distress * NDI
83
DR ER: PT MGMT
* Hypothermia * \<27wk or \<1kg - plastic wrap, thermal mattress * Room temp - 23-25C (74-77F) * Breathing * CPAP - non invasive vent improve outcomes * Lowest PIP necessary (protective ventilation) * Surfactant - esp extremely PT w intubation * Increase compliance * Decrease pressure for effective ventilation * NDI * Gentle handling and vent * Positioning * NO unnecessary stimulation
84
DR ER: Pneumothorax s/s
* Poor response w adequate ventilation * Sudden decompensation * Decrease unilateral breath sounds * Positive transillumination
85
DR ER: Pierre Robin Sx MGMT
* Prone * Pos insert ET into nare
86
DR ER: Choanal Atresia s/s
* blue breathing, pink crying * cant pass NG tube
87
DR ER: Choanal Atresia MGMT
* Airway through mouth always open * Modified pacifier into mouth for PPV * ET into mouth
88
DR ER: CDH MGMT
* NO air in stomach * NO PPV * Intubate asap * OG w continuous or intermittent suction
89
DR ER: Myelomengocele MGMT
* Latex free * Avoid position back * Avoid drying or rubbing defect
90
DR ER: Gastroschisis, Omphalocele MGMT
* Lower body in plastic bag * Position R side (optimize bowel perfusion)
91
DR ER: Maternal Trauma Complications
* Hypoveolmia * HIE * Birth trauma
92
DR ER: Abruption/prolapsed cord Complicaitons
* Hypovolemia * HIE
93
DR ER: Shoulder Dystocia Complications
* Birth trauma * HIE
94
DR ER: Maternal Trauma MGMT
* Volume expansion * UVC * Careful handling
95
DR ER: Abruption/Prolapsed Cord MGMT
* UVC * Volume expansion * Chest compressions * Epinephrine
96
DR ER: Shoulder Dystocia MGMT
* Careful handling * Intubation * Chest compressions
97
Periviable: Definition
22-24wk
98
Periviablity: Incidence for 23wk
* 38% 23wk admitted to NICU survive * 35% 23wk survivors w/o sig NDI
99
Congenital Anomalies: Incidence
3% births major structural or genetic birth defect
100
NRP: when consider withdrawal care
* poor response resuscitation and NO HR 20min

NNP I (9 decks)

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