What is the single most important and effective step in neonatal resuscitation? - ANSWER-Ventilation of the newborn's lungs
Abnormal Transition
... [Show More] Findings - ANSWER--Irregular Breathing, absent breathing, or rapid breathing
-Slow or fast heart rate
-Decreased Muscle Tone
-Pale Skin or Blue Skin
-Low oxygen saturation
-Low blood pressure
NRP algorithm- First Step - ANSWER-Antenatal Counselling
Team Debriefing
Equipment Check
After the birth of the baby, what do you ask? - ANSWER-1. Term Gestation?
2. Good Tone?
3. Breathing or crying?
FIVE INITIAL STEPS:
If you answer NO to any of the three questions (term, tone, breathing) what do you do? - ANSWER-Warm
Dry
Stimulate
Position airway
Suction if needed
Apnea or gasping? HR <100bpm= NO with laboured breathing/cyanosis - ANSWER-Position airway, suction if needed
Pulse oximeter
Oxygen if needed
Consider CPAP
Apnea or gasping? HR <100bpm= YES - ANSWER-PPV
Pulse Oximeter
Consider Cardiac Monitor
HR STILL less than 100bpm= YES - ANSWER-Ensure adequate ventilation
Consider ETT or laryngeal mask
Cardiac Monitor
HR <60 bpm? - ANSWER-ETT or laryngeal mask
Chest compressions
Coordinate PPV-100% oxygen
UVC
HR STILL <60 bpm? - ANSWER-IV Epinephrine every 3-5 minutes
If still less than 60, consider hypovolemia or pneumothorax
Rapid Evaluation - ANSWER-Determine if the newborn can remain with the mother or should be moved to the radiant warmer for further evaluation
REVIEW: Three questions you ask during rapid evaluation? - ANSWER-1. Term?
2. Good Muscle Tone?
3. Breathing/crying?
If the answer is NO to any of these, baby should be brought to radiant warmer.
Airway - ANSWER-Perform the initial steps to establish an open Airway and support spontaneous respiration
Breathing - ANSWER-PPV is provided to assist Breathing for babies with apnea or bradycardia
Circulation - ANSWER-If severe bradycardia persists despite assisted ventilation, Circulation is supported by performing chest compressions coordinated with PPV
Drug - ANSWER-If severe bradycardia persists despite assisted ventilation and coordinated chest compressions, the Drug Epinephrine is administered as coordinated PPV and chest compressions continue
What are the 4 pre-birth questions to ask the provider before every delivery? - ANSWER-1. Expected Gestational Age
2. Is the amniotic fluid clear?
3. Are there any additional Risk Factors?
4. What is our umbilical cord management plan?
Equipment Check- Warm - ANSWER--Preheated radiant warmer
-Towels/Blankets
-Temp Sensor/sensor cover
-Hat
-Plastic Wrap (<32 weeks)
-Thermal Mattress (<32 weeks)
Equipment Check- Clear the airway - ANSWER--Bulb Syringe
-10F or 12F Suction catheter attached to wall suction set at 80-100mm Hg
-Tracheal Aspirator
Equipment Check- Auscultate - ANSWER--Stethoscope
Equipment Check- Ventilate - ANSWER--Sets flowmeter to 10 L/min
-Sets oxygen blender to 21% (21-30 if less than 35 weeks gestation)
-Checks presence/function of PPV devices, including pressure settings and pressure pop-off valves
-Sets T-Piece resuscitator at peak inflation pressure
(PIP=20-25cm H20 for term, 20cm H20 for preterm) (PEEP= 5 cm H20)
-Term and preterm sized masks
-Laryngeal mask (size 1) and 5ml syringe
-5F or 6F orogastric tube if insertion port present on laryngeal mask
-8F orogastric tube and 20ml syringe
-Cardiac Monitor and leads
Equipment Check- Oxygenate - ANSWER--Equipment to give free-flow oxygen
-Target Oxygen Saturation Table
-Pulse Oximeter with sensor and sensor cover
Equipment Check- Intubate - ANSWER--Laryngoscope with size 0/1 straight blades and bright light
-Stylet
-Endotracheal tubes (2.5/3.0/3.5)
-Co2 Detector
-Measuring tape and/or endotracheal tube insertion depth table
-Waterproof tape
-Scissors
Equipment Check- Medicate - ANSWER-Ensure access to:
-Epinephrine (1mg/10ml=0.1mg/mL)
-Normal Saline (100/250ml bag or syringes)
-Supplies for administering medications and placing emergency umbilical venous catheter
-Pre-calcuated medication dose chart
When do you use pulse oximetry and the Target Oxygen Saturation Table to guide oxygen therapy? - ANSWER-1. When resuscitation is anticipated
2. To confirm your perception of persistent central cyanosis
3. If you give supplemental oxygen
4. If PPV is required
How do you evaluate the newborns response to the initial steps? - ANSWER-Assess the newborns respirations to determine if the baby is responding to the initial steps.
If the baby has not responded to the initial steps within the first minute of life, it is not appropriate to continue with only tactile stimulation.
This should take NO more than 30 additional seconds
REVIEW: Initial Steps - ANSWER-Warm
Dry
Stimulate
Position Airway
Suction if needed
After initial steps, what do you do if the baby is apneic/gasping? - ANSWER-If apneic/gasping= PPV
Call for immediate additional help
If the baby is breathing after initial steps, assess the heart rate. What should the heart rate be? - ANSWER-The heart rate should be at least 100.
If LESS than 100, start PPV even if the baby is breathing
How do you estimate the heart rate quickly? - ANSWER-Count the number of beats in 6 seconds and multiply by 10. Clearly report this to your team members.
What do you do if the baby is breathing and the heart rate is at least 100bpm, but the baby appears persistently cyanotic? - ANSWER-If persistent central cyanosis is suspected, a pulse oximeter placed on the right hand or wrist should be used to assess the baby's oxygenation.
When is PPV indicated? - ANSWER-1)Not breathing
2)Gasping
3)HR less than 100
What is the initial oxygen concentration for newborns greater than or equal to 35 weeks gestation? - ANSWER-21%
What is the initial oxygen concentration for preterm newborns less than 35 weeks gestation? - ANSWER-21-30%
What is the ventilation rate? - ANSWER-40-60 breaths per min
Use the rhythm "Breathe, two, three, Breathe, two, three, Breathe, two, three"
What do you set the flowmeter to? - ANSWER-8 L/minute (FH policy)
What is the initial ventilation pressure? - ANSWER-20-25 cm H20 (PIP)
Initial settings for PPV - ANSWER-O2= 21%
Gas Flow= 8 L/min
Rate= 40-60 breaths/min
PIP= 20-25 cm H20
PEEP= 5 cm H20
What is the most important indictor of successful PPV? - ANSWER-Rising heart rate
TRUE OR FALSE: Once PPV begins, an assistant should apply a pulse oximeter to assess baby oxygen saturation - ANSWER-TRUE
Within 15 seconds of starting PPV.... - ANSWER-The baby's heart rate should be increasing
If the baby's heart rate is NOT increasing after 15 seconds, what do you do? - ANSWER-Ask your assistant if the chest is moving
If the chest is moving... - ANSWER-Continue PPV while you monitor your ventilation technique. You will check again after 30 seconds of PPV
If the chest is NOT moving - ANSWER-You may NOT be ventilating the baby's lungs. Perform MR.SOPA until you achieve chest movement with PPV
Within 30 seconds of starting PPV, the baby's heart rate.... - ANSWER-should be greater than 100bpm
If the HR is not increasing within the first 15 seconds of PPV and you do not observe chest movement, what do you do? - ANSWER-Start the ventilation corrective steps
What are the ventilation corrective steps? - ANSWER-MR. SOPA
What are the ventilation corrective steps? - ANSWER-MR. SOPA
M- Mask Adjustment - ANSWER-Reapply the mask and lift the jaw forward. Consider the two hand hold
R- Reposition the head and neck - ANSWER-Place head neutral or slightly extended
After attempting M and R (mask adjustment and repositioning), what do you do? - ANSWER-Give 5 breaths and assess chest movement. If not chest movement do the next steps
S- Suction the mouth and nose - ANSWER-Use a bulb syringe or suction catheter
O- Open the mouth - ANSWER-Use a finger to gently open the mouth
After attempting MR and SO, what do you do? - ANSWER-Give 5 breaths and assess chest movement, if no chest movement, do the next step.
P- Pressure Increase - ANSWER-Increase in 5-10cm H20 increments to maximum recommended pressures
-MAX 40cm in term
-MAX 30 in preterm
After the pressure increase... - ANSWER-Give 5 breaths and assess chest movement. If no chest movement, do the next step
A- Alternative airway - ANSWER-Insert a laryngeal mask or endotracheal tube
If the baby cannot be successfully ventilated with a face mask and intubation is unfeasible or unsuccessful, what do you use? - ANSWER-A laryngeal mask may provide a successful rescue airway
If the HR remains less than 60bpm despite at least 30 seconds of face-mask PPV that inflates the lungs, what do you do? - ANSWER-1. Reassess your ventilation technique
2. Consider Mr.Sopa
3. Adjust the Fi02 as indicated by pulse oximetry
4. Insert an alternative airway
5. Provide 30 seconds of PPV through an alternative airway
After these steps, if the HR remains less than 60bpm, increase FiO2 to 100% and begin chest compressions.
When should an orogastric tube be inserted to act as a vent for gas in the stomach? - ANSWER-If you continue face mask PPV or CPAP for more than several minutes
What colour does a Co2 detector turn if you are effectively ventilating the lungs? - ANSWER-YELLOW during each exhalation
When do you consider CPAP? - ANSWER-If the baby is breathing spontaneously and has a heart rate of at least 100bpm, but has laboured or grunting respirations or low oxygen saturation
Is a technique for maintaining pressure within the lungs of a spontaneously breathing baby
What are the MR. SOPA steps? - ANSWER-Mask Adjustment.
Reposition head and neck.
Suction mouth then nose.
Open mouth.
Pressure increase.
Alternative Airway.
When do you insert an endotracheal tube? - ANSWER-If the baby's HR remains less than 100 bpm and is not increasing after PPV with a face mask or laryngeal mask.
An endotracheal tube should be inserted for direct tracheal suction if the trachea is obstructed by thick secretions, for surfactant admin, and for stabilization of a newborn with a suspected diaphragmatic hernia
Do you insert an endotracheal tube prior to chest compressions? - ANSWER-Insertion of an endotracheal tube is strongly recommended before starting chest compressions. If intubation is not successful or feasible, and the baby weighs more than 2kg, a laryngeal mask may be used.
What size laryngoscope blade for a term newborn? - ANSWER-No 1
What size laryngoscope blade for preterm newborn? - ANSWER-No 0
How do you confirm endotracheal tube insertion within the trachea? - ANSWER-Exhaled Co2 and observing a rapidly increasing HR
If a correctly inserted endotracheal tube does not result in PPV with chest movement, what do you suspect? - ANSWER-Airway obstruction and suction the trachea with a suction catheter or tracheal aspirator
If a baby's condition worsens after endotracheal intubation, list 4 possible causes. - ANSWER-Displaced
Obstructed
Pneumothorax
Equipment Failure
(DOPE)
When are chest compressions indicated? - ANSWER-When the heart rate remains less than 60 beats per minute after 30 seconds of positive-pressure ventilation that moves the chest, preferably through an alternative airway.
If the chest is to moving with PPV, the lungs have not been inflated and chest compressions are not yet indicated.
If the heart rate is less than 60bpm, the pulse oximeter may not have a reliable signal, therefore... - ANSWER-When chest compressions begin, ventilate using 100% oxygen until the heart rate is at least 60bpm and the pulse oximeter has a reliable signal
Proper technique for chest compressions - ANSWER-Place your thumbs on the sternum, in the centre, just below an imaginary line connecting the baby's nipples. Encircle the torso with both hands. Suppor [Show Less]