NERPS Flashcards by Jordan Wight

What % of newborns require SOME breathing assistance?

10%

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What percent of new borns require extensive resuscitative efforts?

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Birth Asphyxia rates

23% of neonatal deaths each year world wide

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What 3 questions need to be asked initially for good neonatal functioning

Term gestation?

Breathing or crying?

Good tone?

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The most important and effective action in neonatal resuscitation?

Ventilating the babies lungs

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Before birth the babies lungs are filled with

Fluid and expanded

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If the baby does not begin breathing in response to stimulation they are assumed to be in ________and ___________ should be provided

Secondary Apnea

Positive pressure Ventilation PPV

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If the baby is in secondary apnea then the pulse will subsequently _________ and the blood pressure will _________

Fall
And
Fall

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We can know that the baby’s adequate ventilation is restored when

The pulse improves rapidly

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Premature babies and some risks associated.

Any baby born before 37 completed weeks of gestation

lungs deficient in surfactant
immature brain development
weak muscles (spontaneous breathing more difficult)
thin skin
high likelihood of infection
fragile blood vessels in brain
small blood volume (Hypovolemia)
immature tissues

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Targeted pre-ductal spo2 levels after birth

1 min= 60-65
2min= 65-70
3min= 70-75
4min= 75-80
5min= 80-85
10min= 85-95

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Pre ductal spo2 @ 1min

60-65

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Pre ductal spo2 @ 2 min

65-70

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Pre ductal spo2 @ 3 min

70-75

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Pre ductal spo2 @ 4min

75-80

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Pre ductal spo2 @ 5min

80-85

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Pre ductal spo2 @ 10min

85-95

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When deciding which babies are “vigorous” what 3 characteristics are needed?

Good Breathing

Good Muscle Tone

HR above 100

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What size of catheter is needed to clear the oropharynx before inserting a ET tube?

12-14 French

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The newborn is covered in meconium, is breathing well, has normal muscle tone, has a heart rate of 120, and is pink. What is the correct action for suctioning?

Suction the mouth and nose with a bulb syringe or suction catheter.

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A new born is still not breathing after a few seconds of stimulation. What is the next action?

Administer PPV

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You have stimulated a new born and suctioned their mouth. It is now 30 seconds after birth, and she is still apneic and pale. Her heart rate is 80. Your next action is

Provide PPV

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MR SOPA

Mask seal

Reposition Airway

Suction Mouth and nose

Open Mouth

Pressure Increase

Airway Adjunct (alternative)

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Full term in weeks

End of 27-40

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APGAR

Appearance Pulse Grimace Activity Respirations

Fluid replacement amount in neonates

10ml/kg over 5-10 mins

Measuring OG tubes in neonates

Measure the distance from the nose to the earlobe and then from the earlobe to a point halfway between the xiphoid process and the umbilicus

Size of OG tube

How far should a OG tube be inserted (cm)

Assisted ventilation may be discontinued when:

Heart rate is above 100bpm Sustained spontaneous breathing is present

Hold resuscitation device so you can see the newborns_________

Chest and abdomen

A baby is born apneic and cynotic. You clear the airway and stimulate. Thirty seconds after birth the baby has not improved, the next step is to

Begin PPV

Self inflating bags require the attachment of _________________ to deliver a high concentration of oxygen.

Oxygen reservoir

Principle safety features of FLOW INFLATING bags

Pop off valve Pressure gauge

Principle safety features of SELF INFLATING BAGS

Pressure gauge

Principle safety features of T PIECE RESUCITATOR

Maximum pressure relief control Pressure gauge

PPV rates for ventilation neo nates

40-60 breaths per minute

Begin PPV with an initial inspiratory pressure of ___________

20 cm of water

Assess PPV BY ____________ and ____________ then listening for _________________. If these signs are unacceptable then look for ________________

HR and SPo2 Lung sounds Chest rise

After 30 second of PPV what do you do if the babies HR is below 60

Begin chest compressions and consider intubation

After 30 seconds of PPV you babies HR is greater than 60 but less than 100 but steadily improving. What do you do?

Adjust oxygen, gradually decrease pressure as rate improves, insert OG and continue monitoring

After 30 seconds of PPV the babies HR is above 60 but less than 100 and not improving. What should be done?

Do MR SOPA and consider intubation

The preferred chest compression technique is

The thumb technique

The correct depth of compressions is

One third of the anterior-posterior diameter of the chest

Compression area of neo nate chest

Lower third of the sternum between the xyphoid process and a line drawn between the nipples

Ratio for compressions to breaths

3:1

The rate of ventilations without chest compressions is

40-60

There should be how many "events" during chest compressions?

120

The three compressions and one breath should take

2 seconds

Size of ET tube for babies below 1000g or below 28 weeks

2.5

ET tube size for baby between 1000-2000g or 28-34 weeks

3.0

ET tube size for baby 2000-3000g or 34-38 weeks

3.5

ET tube size for baby above 3000g or above 38 weeks

3.5-4.0

The neonatal intubation procedure should take more than

30 seconds

Neonate intubation steps

- Stabilize head in sniffing position - slide laryngoscope on right to left. - lift blade - look for landmarks - Insert tube - if chords closed wait for them to open - brace tube against hard palate

Useful situations for LMA

Facial or upper airway malformations render ventilation by mask ineffective Iff PPV not working and ET intubation not possible.

Fewer than what percent of babies need Epi to stimulate their hearts

Effective ventilation and coordinated chest compressions have been preformed for 45-60 seconds, the trachea has been intubated, and the baby's heart rate is below 60 beats per minute. You should now ______________ while continuing chest compressions and ________________

Give epinephrine Ventilation

What is the potential problem with administering Epi through an endotracheal tube?

Epi is not reliably absorbed in the lungs. A higher dose (0.5-1ml/kg) should be considered.

The recomended dose of epi for new borns is _________ to __________ml/kg IV or __________ to __________ml/kg ET

0. 1-0.3 ml/kg IV | 0. 5-1.0 ml/kg ET

If the neo nate appears to be in shock there is evidence of blood loss. And resuscitation is not resulting in improvement, you should consider giving _____________ via _____________

10ml/kg of volume expanders via umbilical vein

Therapeutic hypothermia in neonates

33.5-34.5 c

Choanal Atresia can be ruled out by what procedure?

Passing a NPA through the nares to assess for obstruction of the skull

Babies with robin syndrome who have upper airway obstruction may be helped by placing a ___________ and positioning them ______________. Endotracheal of such babies is usually _______

Nasopharyngeal tube Prone on their abdomen Difficult

You should suspect a congenital diaphragmatic hernia if ___________. Such babies should not be resuscitated with _____________.

Flat appearing scaphoid abdomen present PPV by mask

NERPS Flashcards

(65 cards)