2.3 Resuscitation Life Support E) Paediatric- Neonatal

Front 1

In regards to Neonatal Resuscitation, which of the following is incorrect?

A. Compressions are performed at a rate of 120 / min

B. The ventilation rate is performed at 40-60 / min

C. The ratio of compressions to ventilations is 4:1
D. The heart rate at which compressions are commenced is < 60.

Back 1

C. Compressions: Ventilations = 3:1

** Ventilation rate 40-60/ min initially

Rate 30-40 /min when compressions started

Front 2

In regards to the Neonatal Resuscitation

Algorithm, which of the following is incorrect?
A. The Stepwise progression is repeated and staged at 30 second cycles.
B. The initial part of the algorithm entails stimulation with drying and clearing the airway.
C. The APGAR is scored at Time 0 and 5 minutes.
D. The Umbilical vein is the larger, single vessel.

Back 2

C. APGAR is at 1 and 5 minutes

Front 3

In regards to the Neonatal Resuscitation

algorithm, which of the following is incorrect for a Term delivery?
A. Chest compressions and ventilations are are performed at a 3:1 ratio
B. Chest compressions are performed at a rate of 120 per minute
C. Positive pressure ventilation is initially performed with air > 100% oxygen.
D. Intubation would be with a size 3.0 ETT.

Back 3

D. ETT with size 3.5 Tube

< 28 weeks (weight <1kg) = 2.5 ETT

28-34 weeks ( wt.1-2 kg) = 3.0 ETT

34-38 weeks ( wt. 2-3 kg ) = 3.5 ETT

> 38 weeks ( wt 4 kg ) = 4.0 ETT

Front 4

In regards to Neonatal resuscitation, which of the following is incorrect?
A. Neonatal hypoglycaemia is treated with 10mL/kg of 10% dextrose
B. Adrenaline is given Intraosseous (I/O)at 0.1 mg/kg 1:10,000
C. The gas flow for the Neopuff is set at 8 L/min
D. The Neopuff PIP is set at 30 cmH2O and PEEP of 5 cm H2O

Back 4

B. Adrenaline = 0.1 mL / kg 1: 10,000

Intraosseous OR Umbilical vein

Front 5

In regards to the use of the Neopuff in Neonatal Resuscitation, which of the following is incorrect?
A. PIP is given when the PEEP valve is occluded.
B. The PEEP valve occlusion time should be equal to the unoccluded time, in a ratio of 1:1
C. The oxygen flow rate is set at 15 L/min
D. The ventilation rate is at 30-40 min ( with compressions)

[ 40 - 60/min without compressions].

Back 5

C. Oxygen flow rate set at 8 L /min

Front 6

In regards to APGAR scoring, which of the

following is correct?
A. The minimum score is 3, and maximum is 10, at 1 and 5 minutes.
B. There are 4 factors, including colour, HR and RR.
C. Muscle tone and reflex irritability are 2 separate components of the score.
D. A HR < 100, with absent RR and cyanosis is an indication to first

commence compressions.

Back 6

C.

A = Minimum score 0
B = 5 factors [ HR,RR,Muscle tone,Reflex

irritability and colour]
D = dry and stimulate -clear airway - review- next then is to give positive pressure

ventilation (PPV) ...

Front 7

[ Tintinalli]

Which is incorrect regarding the Airway and breathing management of the newborn ?

A. The mouth and nose are cleared of secretions at delivery with a bulb syringe.

B. The use of mechanical wall suction is not advised.

C. Meconium in the amniotic fluid is an aspiration risk.

D. Meconium is noted in 15-20% deliveries.

Back 7

B. Mechanical wall suction with an 8F suction catheter can be used.

Front 8

[ Tintinalli]

In regards to Meconium in the newborn

delivery, which of the following is incorrect ?

A. Aspiration of meconium-stained fluid is rare

B. 15-20% deliveries have meconium presence noted.

C. Meconium aspiration can cause pulmonary hypertension

D. A limp, poorly responsive newborn with

meconium -stained amniotic fluid requires ETT-tracheal suctioning.

Back 8

B. 15-20%

** Updated Guidelines 2015 : Insufficient evidence to support routine tracheal intubation for suctioning of meconium in even non-vigourous infants born through meconium-stained

amniotic fluid, because it likely delays ventilation

Front 9

[ Tintinalli]

What are the 2 main complications of

meconium aspiration in the newborn?

Back 9

1. Severe respiratory compromise

2. Persistent pulmonary hypertension.

Front 10

[ Tintinalli ]

List 5 indications for endotracheal intubation in the newborn.

Back 10

1. Tracheal suctioning of meconium**

2. Need for chest compressions

3. Administration of ETT medications

4. Known/ suspected congenital

diaphragmatic hernia

5. Birth weight < 1000g (1 kg)

Front 11

[ Tintinalli]

In regards to endotracheal suctioning of

meconium, which is correct ?

A. Wall suction is set at 60mmHg when connected to the ETT.

B. Active resuscitation should be commenced if the newborn remains

severely depressed after all the meconium is aspirated.

C. Meconium aspiration causes pulmonary hypotension.

D. All meconium deliveries with a poorly responsive newborn require

indirect suctioning prior to active resuscitation.

Back 11

B.

A = Wall suction set at 80-100 mmHg

C = Pulmonary hypertension

D = Direct tracheal suctioning. **

[ Updated guidelines 2015 ]

Front 12

[ Tintinalli ]

In regards to bag-mask ventilation in the

apnoeic / bradycardic newborn, which of the following is incorrect?

A. Tactile stimulation and drying is the first intervention.

B. Blow-by oxygen is the second intervention.

C. Positive pressure ventilation is the 3rd intervention.

D. Ventilation is at a rate of 30-40 / minute.

Back 12

D. 40-60 / minute initially

Front 13

[ Tintinalli]

In regards to oxygen delivery in the newborn, which of the following is incorrect ?

A. Bag-mask ventilation with room air may be as successful as using 100% oxygen in the apnoeic newborn.

B. The Term newborn should receive 100% oxygen.

C. Full Term newborns require inflation pressures of 30-35 cm/ H2O

D. Pre-Term newborns require inflation pressures of 25-30 cm/H2O

Back 13

D. Pre-Term Newborns require inflation

pressures of 20-25 cm / H2O

Front 14

[ Tintinalli]

Which Gestational age range and

equipment link is correct?

A. 28-34 weeks ---> ETT 3.0 Miller 1 blade

B. > 38 weeks ----> ETT 4.0 Miller blade 1

C. 28-34 week ----> ETT 3.0 Miller blade 0

D. < 28 weeks ----> ETT 2.5 Miller blade 1

Back 14

B.

A : 28-34 weeks = ETT 3.0 Miller blade 0

D : < 28 weeks = ETT 2.5 Miller blade 0

Front 15

[ Tintinalli]

Which is incorrect regarding ETT tubes in the newborn ?

A. (Pre) Cutting the ETT at 13cm avoids kinking and excessive dead space

B. The ETT will be properly placed if the dark marking level is at the

vocal cords.

C. The ETT securement at the newborns lips is calculated by

8 + weight (kg)

D. Right mainstream bronchus intubation is common.

Back 15

C. ETT cm marker at lips = 6 + weight (kg)

Front 16

List the components of the A and P of the

APGAR Scoring System.

Back 16

Activity

Absent / Flexed arms-legs / Active

Pulse

Absent / < 100 / > 100

Front 17

List the components of the G and A of the

APGAR scoring system.

Back 17

Grimace ( upon stimulation )

No response / grimace / pulls away-cough

Appearance

Cyanosed-grey / extremity pallor-cyanosis / pink

Front 18

what does the R component of the

APGAR scoring system represent.

Back 18

Respirations

Absent / slow-irregular / crying

Front 19

Detail the components of a Score of 1 with the APGAR Scoring System .

Back 19

Activity : Flexed arms / legs

Pulse : HR < 100

Grimace : grimace with stimulation

Appearance : extremity pallor / cyanosis

Respiration : slow / irregular