Questions and Answers
When is placement of an endotracheal tube strongly recommended?
When the baby's heart rate remains less than 100 bpm and is not increasing.
During a delivery, when and where should a person with intubation skills be available?
In the hospital and immediately available.
What are the primary methods of confirming endotracheal tube placement within the trachea?
Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate.
What is the likely reason for a colorimetric CO2 detector not turning yellow after intubation?
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When is a cardiac monitor recommended to assess the baby's heart rate during resuscitation?
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What size laryngoscope blade is recommended to intubate a preterm newborn with an estimated gestational age of 32 weeks?
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What is the preferred way to assess the heart rate during chest compressions?
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Which method is preferred to assess the heart rate in a newborn at birth with low heart rate and poor perfusion?
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When are chest compressions indicated?
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What action should you take after 60 seconds of PPV coordinated with chest compressions, with a heart rate of 70 bpm?
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What is the recommended depth of chest compressions?
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During chest compressions, how should compressions and ventilations be coordinated?
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What volume of normal saline flush should you administer after intravenous epinephrine in a newborn whose heart rate remains less than 60 bpm?
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What is the suggested initial dose for IV epinephrine?
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When is the administration of a volume expander indicated during newborn resuscitation?
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At what rate should 10 mL/kg of normal saline be administered for a newborn with poor perfusion?
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How soon after intravenous epinephrine administration should you pause compressions and reassess the baby's heart rate?
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What concentration of oxygen will you use initially if PPV is required for a newborn at 30 weeks gestation?
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What is the most appropriate next step for a baby born at 26 weeks gestation who is not breathing after initial care?
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Choose the appropriate step(s) to prepare for the birth of a newborn.
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Study Notes
Endotracheal Tube Placement
- Endotracheal tube placement is strongly indicated if the baby's heart rate stays below 100 bpm and shows no signs of increasing after 30 seconds of face-mask PPV with chest movement.
Availability of Intubation Skills
- A person skilled in intubation should be readily available in the hospital during delivery.
Confirming Tube Placement
- Placement confirmation can be achieved through exhaled carbon dioxide (CO2) detection and observing a rapidly increasing heart rate.
Low Cardiac Output
- In resuscitation scenarios, a colorimetric CO2 detector not turning yellow despite correct tube placement and bilateral breath sounds often indicates low cardiac output.
Cardiac Monitor Usage
- A cardiac monitor should be utilized to assess heart rate when an alternative airway is inserted during neonatal resuscitation.
Recommended Laryngoscope Blade Size
- For a preterm newborn of approximately 32 weeks gestation, a size 0 laryngoscope blade is recommended for intubation.
Assessing Heart Rate During Compressions
- Interrupt chest compressions briefly every 60 seconds for heart rate assessment using a cardiac monitor to ensure effectiveness.
Assessing Heart Rate at Birth
- In newborn resuscitation, a cardiac monitor is the preferred tool for heart rate assessment when low heart rate and poor perfusion are present.
Indications for Chest Compressions
- Chest compressions are warranted if the heart rate stays below 60 bpm for more than 30 seconds after effective PPV.
Actions Following Cardiac Monitor Readings
- If, after 60 seconds of coordinated PPV and chest compressions, the heart rate reads 70 bpm, cease chest compressions and continue PPV.
Depth of Chest Compressions
- Chest compressions must reach a depth equivalent to one-third of the anterior-posterior diameter of the chest.
Coordination During Chest Compressions
- The compressor should maintain rhythm by verbally coordinating compressions and ventilations through counting.
Volume of Normal Saline Flush
- Administer a 3 mL normal saline flush after intravenous epinephrine for a newborn whose heart rate is below 60 bpm despite effective resuscitation efforts.
Dosage of IV Epinephrine
- The recommended initial dose for intravenous epinephrine in neonatal resuscitation is 0.02 mg/kg, or 0.2 mL/kg.
Indications for Volume Expanders
- A volume expander is indicated when the heart rate is stagnant, and there are signs of shock or a history indicating acute blood loss.
Administration Rate of Normal Saline
- In cases of acute blood loss, normal saline should be administered at a rate of 10 mL/kg over 5 to 10 minutes.
Timing for Heart Rate Reassessment
- Heart rate assessment should occur 60 seconds post intravenous epinephrine administration, with compressions paused to check effectiveness.
Initial Oxygen Concentration
- For a newborn requiring PPV at 30 weeks gestation, begin with an oxygen concentration between 21% to 30%.
Next Steps for Non-Breathing Newborns
- If a baby born at 26 weeks is not breathing after initial care steps, the immediate action is to begin PPV via mask.
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Description
Test your knowledge on the Neonatal Resuscitation Program (NRP) 8th Edition with these flashcards. This quiz covers essential scenarios and guidelines for managing newborns during resuscitation. Perfect for healthcare professionals looking to enhance their skills in neonatal care.
