NRP 8th Edition Questions and Answers(A+ Solution guide)

What is the single most important and effective step in neonatal resuscitation? - Ventilation of the newborn's lungs Abnormal Transition Findings - -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 - Antenatal Counselling Team Debriefing Equipment Check After the birth of the baby, what do you ask? - 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? - Warm Dry Stimulate Position airway Suction if needed Apnea or gasping? HR <100bpm= NO with laboured breathing/cyanosis - Position airway, suction if neededPulse oximeter Oxygen if needed Consider CPAP Apnea or gasping? HR <100bpm= YES - PPV Pulse Oximeter Consider Cardiac Monitor HR STILL less than 100bpm= YES - Ensure adequate ventilation Consider ETT or laryngeal mask Cardiac Monitor HR <60 bpm? - ETT or laryngeal mask Chest compressions Coordinate PPV-100% oxygen UVC HR STILL <60 bpm? - IV Epinephrine every 3-5 minutes If still less than 60, consider hypovolemia or pneumothorax Rapid Evaluation - 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? - 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 - Perform the initial steps to establish an open Airway and support spontaneous respiration Breathing - PPV is provided to assist Breathing for babies with apnea or bradycardia Circulation - If severe bradycardia persists despite assisted ventilation, Circulation is supported by performing chest compressions coordinated with PPV Drug - 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? - 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 - -Preheated radiant warmer -Towels/Blankets -Temp Sensor/sensor cover -Hat -Plastic Wrap (<32 weeks) -Thermal Mattress (<32 weeks) Equipment Check- Clear the airway - -Bulb Syringe -10F or 12F Suction catheter attached to wall suction set at 80-100mm Hg -Tracheal AspiratorEquipment Check- Auscultate - -Stethoscope Equipment Check- Ventilate - -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 - -Equipment to give free-flow oxygen -Target Oxygen Saturation Table -Pulse Oximeter with sensor and sensor cover