NRP 8th Ed Lesson 5 and 6 Questions and Answers 100% Correct

NRP 8th Ed Lesson 5 and 6 Questions and Answers 100% Correct When should insertion of an ETT be considered/used? A. Baby's HR <100 bpm and is not increasing after PPV w/face mask or laryngeal mask. B. It is recommended before chest compressions C. SHould be inserted for direct tracheal suction if the trachea if the trachea is obstructed by thick secretions, for surfactant admin., and stabilization of a newborn w/suspected diaphragmatic hernia. D. If PPV is prolonged,an ETT may be considered to improve the efficacy and ease of assisted ventilation. What are the Neonatal anatomic landmarks in the airway? 1. Esophagus. 6. Vocal cords 2. Epiglottis. 7. Trachea 3. Vallecula. 8. Thyroid 4. Larynx. 9. Carina 5. Glottis. 10. Main bronchi What laryngoscope do we use for infants? Miller blade, it is straight What are the sizes of the Miller blade available in? No. 1 blade (term newborn) No. 0 blade (preterm newborn) No. 00 (optional for extremely preterm newborn) ETT sizes 1. Below 1 Kg, below 28 wks, ETT size 2.5 mm ID/Blade size 00 2. 1-2 Kg, 28-34 wks, ETT size 3.0 mm ID/Blade size 0 3. >2 Kg, >34 wks, ETT size 3.5 mm ID/Blade size 1 What supplies and equipment Should we have on hand for intubation? 1. laryngoscope handle (extra batteries) 2. laryngoscope blades 3. ETT (correct size, one size smaller and one size larger) 4. stylet 5. CO2 detector 6. Suction set up 7. waterproof adhesive tape or other tube-securing device 8. measuring tape and/or ETT insertion depth table 9. Scissors to cut tape 10. tracheal aspirator 11. stethoscope 12. PPV device (bag or T-piece resuscitator), tubing for blended air and O2 13. Pulse Ox, sensor, cover 14. laryngeal mask (size 1) as a rescue airway How much time is allowed to intubate? 30 seconds How do we confirm ETT placement for neonates? 1. ETCO2 detector and CXR 2. Rapidly raising HR 3. Bilateral chest rise 4. audible and equal breath sounds near both axillae during PPV 5. little or no air leak from the mouth during PPv 6. decreased or absent air entry over the stomach How deep should the ETT be inserted? The tip of ETT is only 1-2 cm below the vocal cords. What two methods are used to estimate insertion depth of ETT? 1. nasal-tragus length (NTL), this is a calculation based on the distance (cm) from the baby's nasal septum to the ear tragus. Use a measuring tape to measure NTL. the estimated insertion depth (cm) is NTL + 1 cm. Insert ETT so the marking on the ETT corresponds to the estimated insertion depth. 2. Gestational age is also an accurate predictor of the correct insertion depth. Refer to the "Tip to Lip" chart What does the DOPE mnemonic help you to recognize and what does it stand for? Causes of airway obstruction D= Displaced ETT O= Obstructed ETT P= Pneumothorax E= Equipment failure APGAR scoring A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent) In NRP, what are the situations we call for help in? 1.Multiple babies ( twins or triplet) 2.C-section 3.Meconium aspiration Equipment needed for resuscitation? Gloves and PPE Hat Stethoscope During the initial steps of NRP it is essential to assess the neonate every.......... 30 seconds Intubation supplies for a preterm, 1 Kg neonate includes Size 0,00 blade Size 2.5 ETT Medication for low HR <60/min 1:10,000 Epi 0.1-0.3 mL/Kg Preductal SpO2 is placed and measured right hand or wrist In NRP algorithm, apnea, gasping requires PPV The FiO2 for resuscitating once chest compressions are initiated? 100% The target SpO2 for 1 min of life is? 60%-65% The T-piece resuscitator delivers consistent pressure After 2 min of PPV or CPAP, what should be inserted? An oral gastric tube NRP states for compressions to ventilation ratio 1 and 2 and 3 and breathe Assessment is performed every__________ during compressions 1 minute/60 seconds Where should the compressor stand and what technique is used for compressions? At the head using two thumbs How deep should you compress the chest when giving CPR to a neonate? 1/3 the AP diameter How many compressions to ventilations during CPR? 90:30 Chest compressions begin after 30 seconds of effective PPV w/ETT and HR <60 Condition that diminishes pulse ox reading Hypothermia In the presence of high FiO2 levels of O2, there are potential hazards related to the high partial pressure of O2, what causes this? Pulmonary vasodilation Worsening intrapulmonary shunting decrease in lung compliance Pulse ox can't distinguish between O2Hb or carboxyhemoglobin An external device used to measure PO2 and CO2 on the body PTCO2 (transcutaneous monitor) ETCO2 monitor reveals Curare cleft or medically paralyzed pt, breathing Curare cleft medically paralyzed pt, breathing The TCM (transcutaneous monitor ) is reading 36C, what should the temp be? 41-44C What will effect the TCM readings? Poor perfusion hypothermia vasoconstricting medications Limitations of TCM are Needs time to warm up Needs time to calibrate Site and membrane changes every 4-6 hours What are other acceptable areas to place earlobe thigh upper chest NOT OVER BONES (clavicle and ribs) ETCO2 reveals air trapping or obstruction Air trapping or obstruction ETCO2 monitor reveals pneumothorax pneumothorax ETCO2 monitor reveal rebreathing CO2 rebreathing CO2 What does the C-D represent on the waveform? The completion of an expiration as the alveoli empties ETT in the esophagus measures what EtCO2? 0 or small detection ETCO2 monitor reveals cardiac oscillations cardiac oscillations