Lesson 3 NRP Flashcards by Anonymous Unknown

What’s the most important intervention in neonatal resuscitation?

Early PPV

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List advantages of self inflating bags

-Bags remain inflated unless squeezed
-can deliver air, concentrated oxygen, or a blend
-most have pop off valve to prevent excess pressure being delivered to the lungs

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List disadvantages of self inflating bag

-tight mask seal is required to ventilate
-Cannot deliver CPAP (continuous air)
-pressure release valves only release at very high pressures

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List advantages of flow inflating bags

-Can deliver CPAP
-Pressure can be regulated with manometer
-can deliver positive end expiratory pressure (PEEP) and free flow oxygen

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List disadvantages of flow inflating bags

-tight mask seal is required for bag inflation and ventilation
-requires oxygen source
-practical issues make them difficult to use

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List T piece resuscitator advantages

-can deliver CPAP
-can deliver free flow oxygen
-peak inspiratory pressure can be regulated easily
-built-in manometer measures pressure (inspiratory ‘breathing in’ and expiratory ‘breathing out’)

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List T piece resuscitator disadvantages

-Tight make deal is required
-Needs compressed gas
Easy to forget to release pressure for exhalation

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What 5 steps does the provider need to take before delivering PPV?

1) clear airway
2) assume proper position
3) properly position baby’s head and neck
4) select appropriate mask
5) conceal tight seal with mask

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What’s the proper position for the provider performing PPV?

Above baby’s head, (front of warmer). This position is best in order to place laryngeal mask or ETT if needed. May need to move to the side to administer chest compressions

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If the airway has already been cleared should you suction it again before PPV starts?

Yes that’s good practice.

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What does 1 handed mask seal technique allow you to do also?

Deliver ventilations with free hand

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2 handed mask seal technique will require what

Another provider to provide ventilations

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What’s the best way to secure the mask to the face?

Hold the mask and jaw together. Do not press down on baby’s head. Avoid compressing baby’s airway with downward force.

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Steps 6-7 when preparing for PPV

6) select proper oxygen concentration
7) deliver ventilations at correct pressure and rate.

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What’s the proper oxygen concentration for baby 35+ weeks genstation?

21%

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What’s the proper oxygen concentration for baby >35 weeks genstation?

21%-30% (based on pulse oximetry)

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What’s the starting peak ventilation pressure?

20-25 cm H²O

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The first few breaths may require what pressure? (For baby who is full term)

30-40 cm H²O

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If PEEP is used what ventilation pressure should you start with?

5cm H²O

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What’s the rate of ventilations (bpm)?

40-60

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It’s reasonable to deliver first breath for how long

Over 1 second or less

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What indicates that there is a problem with PPV?

The chest is not rising

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what’s the most important indicator of successful PPV ?

Heart rate increasing

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How long should it take PPV to improve heart rate for baby with bradycardia?

15 seconds

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After 15 seconds what should be announced?

If the heart rate is increasing or not If chest is moving/not moving

If 15 seconds of PPV did not increase heart rate, but the chest is moving, what's next?

Continue PPV another 15 seconds

After 15 seconds of PPV, the heart rate is not increasing, chest is not moving, what's next?

Take corrective steps to get the chest to rise, check for leaks, airway obstructionsor if too little pressure is being delivered

What does MR. SOPA stand for?

Mask adjustment Reposition airway Suction mouth nose Open mouth Pressure increase Alternative airway (ETT or laryngeal mask)

When should the second heart rate assessment be taken?

30sec of PPV that moves chest

At 30 sec heart rate assessment what do you check heart rate with?

Stethoscope, pulse oximeter or ECG

If heart rate is 60-99bpm after 30 sec of effective PPV, what's next?

Check ventilation efforts and make improvements

If heart rate is less than 60 bpm after 30 sec of PPV, what's next?

Place ETT or laryngeal mask and provide 30 sec PPV

After placing ETT or laryngeal mask and delivering 30 more seconds of PPV, heart rate is less than 60 bpm, what's next?

Start chest compressions, supplemental oxygen, administer epinephrine

An ETT or laryngeal mask should be placed by

Properly trained providers, this class doesn't teach how to do this

ETT is the airway of choice and requires a

Laryngoscope

What size laryngoscope blade and ETT for full term baby?

#1 blade

What size laryngoscope blade and ETT for premature baby?

#0 blade

What size laryngoscope blade and ETT for very premature baby?

#00 blade

A 2.5mm ETT tube is used for

Baby's less than 1 kg (2.2lbs) (usually >28 weeks gestation)

A 3.0mm ETT tube is used for

Babies weighing 1-2 kg (2.2-4.4 lbs) (usually 28-34 weeks gestation)

A 3.5mm ETT tube is used for

Babies more than 2kg (4.4 lbs) (usually >34 weeks gestation)

Where should ETT be placed?

1-2 cm below vocal cords (quick measure century of nose to tragus of ear (pointy flap)

It should take no longer than ___ secs to place ETT

30 sec

Should a provider try repeatedly attempt to intubate a neonate? Why?

No, each attempt is traumatizing and inflames airway

A correctly placed ETT should result in

Chest movement and bilateral breath sounds

What can be placed in the ETT to detect products of metabolism and has exchange?

CO² monitor

Positive CO² suggests (ETT placed)

Proper ETT placement

What provide s definite evidence of proper placement of ETT?

Chest X-ray

If neonate conditions worsens after ETT placement what are the 4 possible issues?

(DOPE) Dislodged ETT Obstructed ETT Pneumothorax Equipment problem

A laryngeal mask (LMA) is useful in cases when

Intubation is not possible

Laryngeal make can be helpful when baby has malformations of

Face, jaw, palate

What's the most common laryngeal mask size available? What size baby will this not be useful for?

Size 1, 1,500 g (3.3 lbs usually 28-34 week gestation)

What advantage does the laryngeal mask have

It does not require a laryngoscope

When might a LMA leak air

Around cuff at high pressures

LMA cannot be used to

Clearing airway secretions

How to check proper placement on laryngeal mask?

CO² monitor

How many ventilations should it take in order to detect CO²

8-10 ventilations

What other signs should occur with proper placement of laryngeal mask?

Increased heart rate Increasing SpO² Bilateral chest movement Breath sounds with ventilation

Because air administered through the LMA will enter the esophagus as well as the trachea, what should be inserted into the stomach? What for?

A gastric tube should be inserted into the stomach for decompression

Is LMA used for short-term or long-term

Short term

What increases the longer LMA is in use

Complications

When can LMA be removed

If baby needs transferred to a ETT instead or if baby breathes spontaneously

Since the LMA sits on top of vocal cords what can providers hear to let them know the baby has spontaneous breathing

Crying (an ETT is below the vocal cords so this doesn't work for ETT)