Neonatal Resuscitation Review

Front 1

About what percent of newborns will require some assistance to begin regular breathing?

Back 1

Approximately 10% of newborns require some assistance to begin breathing at birth.

Front 2

About what percent of newborns will require extensive resuscitation to survive?

Back 2

About 1% need extensive resuscitative measures to survive.

Front 3

Chest compressions and medication are (rarely) (frequently) needed when resuscitating newborns.

Back 3

Chest compressions and medication are rarely needed when resuscitating newborns.

Front 4

Before birth, the alveoli in a baby's lungs are (collapsed) (expanded) and filled with (fluid) (air).

Back 4

The fetal lungs are expanded in utero, but the potential air sacs (alveoli) within the lungs are filled with fluid, rather than air.

Front 5

The air that fills the baby's alveoli during normal transition contains what percent oxygen?

Back 5

Air contains 21% oxygen.

Front 6

The oxygen in the baby's lungs then causes the pulmonary arterioles to (relax) (constrict) so that the oxygen can be absorbed from the alveoli and distributed to all organs.

Back 6

As a result of the gaseous distention and increaed oxygen in the alveoli, the blood vessels in the lung tissue relax, decreasing resistance to blood flow.

Front 7

if a baby does not begin breathing in response to stimulation, you should assume he is in which apnea, and you should provide what?

Back 7

If a baby does not begin breathing immediately after being stimulated, he or she is likely in secondary apnea and will require positive-pressure ventilation. Continued stimulation will not help.

Front 8

If a baby is deprived of oxygen and he enters the stage of secondary apnea, his heart rate will (rise) (fall) and his blood pressure will (rise) (fall)

Back 8

If a baby is deprived of oxygen and he enters the stage of secondary apnea, his heart rate will fall and his blood pressure will also fall.

Front 9

Restoration of adequate ventilation usually will result in a (rapid) (gradual) (slow) improvement in heart rate.

Back 9

Compromised newborns usually show a very rapid improvement in heart rate when adequate ventilation is restored.

Front 10

Resuscitation Flow Diagram: What are the four questions to ask about the newborn in your first assessment?

Back 10

1. Term gestation?
2. Clear amniotic fluid?
3. Breathing or crying?
4. Good muscle tone?

Front 11

Resuscitation Flow Diagram: If any answer to the four questions in your first assessment is no, what are your first three actions?

Back 11

1. Provide warmth
2. Position and clear airway (as necessary)
3. Dry, stimulate, reposition

Front 12

Resuscitation Flow Diagram:
The first three actions, after assessment of a newborn are:

Back 12

1. Provide warmth
2. Clear airway as necessary
3. Dry, stimulate, reposition

Front 13

Resuscitation Flow Diagram:
How long should it take you to make your initial assessment and provide warmth, a clear airway, and stimulation?

Back 13

You should complete these actions in 30 seconds.

Front 14

Resuscitation Flow Diagram:
As you are drying and stimulating the newborn, what three things are you evaluating simultaneously?

Back 14

As you are drying and stimulating the newborn, assess respirations, heart rate, and color, simultaneously.

Front 15

Resuscitation Flow Diagram:
What are the criteria for proceeding from providing warmth, a clear airway, and stimulation to additional resuscitative measures?

Back 15

Respirations: apnea or gasping.
Heart rate: <100 bpm.
Color: blue (cyanotic)

Front 16

Resuscitation Flow Diagram:
If during your evaluation, the infant is breathing, and his heart rate is >100 bpm, but he is cyanotic, what action should you take?

Back 16

If an infant is breathing, and his heart rate is above 100 bpm, but he is cyanotic, give supplemental oxygen.

Front 17

Resuscitation Flow Diagram: Resuscitation Flow Diagram:
If during your evaluation an infant is apneic or has a heart rate <100 bpm, what action should you take?

Back 17

If an infant is apneic or has a heart rate <100 bpm, provide positive-pressure ventilation.

Front 18

Resuscitation Flow Diagram:
After about 30 seconds of ventilation or supplemental oxygen, you evaluate the newborn again, what criteria signals the need for additional resuscitative measures?

Back 18

If the heart rate is below 60 bpm, chest compressions are needed to provide adequate circulation.

Front 19

Resuscitation Flow Diagram:
Below what heart rate are chest compressions appropriate?

Back 19

If the heart rate is below 60 bpm, administer chest compressions.

Front 20

Resuscitation Flow Diagram:
After about 30 seconds of positive-pressure ventilation and chest compressions, you evaluate the newborn again, what criteria signals the need for additional resuscitative measures?

Back 20

If, after 30 seconds of positive-pressure ventilation and chest compressions, the infant's heart rate is <60 bpm, administration of epinephrine is the next appropriate step.

Front 21

Resuscitation Flow Diagram:
After the administration of epinephrine, the infant's heart rate remains below 60 bpm, what actions are continued and repeated?

Back 21

After administration of epinephrine, positive-pressure ventilation and chest compressions are continued, with evaluation of heart rate every 30 seconds, and additional administration of epinephrine if indicated.

Front 22

When the infant's heart rate rises above 60 bpm, which resuscitative action is discontinued?

Back 22

When the infant's heart rate rises above 60 bpm, chest compressions are discontinued.

Front 23

At what point is positive-pressure ventilation discontinued?

Back 23

Positive-pressure ventilation is discontinued when the heart rate is above 100 bpm and the baby is breathing.

Front 24

What are the two most important heart rate numbers?

Back 24

60 and 100 bpm. A heart rate below 60 indicates that additional resuscitative measures are required. A heart rate above 100 usually indicates that resuscitation procedures can be stopped, unless the patient is apneic.

Front 25

There are four points in the Resuscitation Flow Diagram at which endotracheal intubation may be needed. What are they?

Back 25

1. In Block A, in order to provide a clear airway.
2 and 3. in Blocks B and C, to provide positive-pressure ventilation.
4. In Block D, to administer epinephrine.

Front 26

Resuscitation Flow Diagram:
When is it appropriate to continue a resuscitation step longer than 30 seconds without seeing improvement in the newborn?

Back 26

If you feel that any step is not being delivered effectively, you may need to take longer than 30 seconds to correct the problem.

Front 27

Resuscitation Flow Diagram:
The primary actions in neonatal resuscitation are aimed at what?

Back 27

The primary actions in neonatal resuscitation are aimed at ventilating the baby's lungs (Blocks A & B).

Front 28

Resuscitation Flow Diagram:
Once ventilation of the baby's lungs is accomplished, what 3 things usually improve spontaneously?

Back 28

Once the baby's lungs are ventilated, heart rate, blood pressure, and pulmonary blood flow usually improve spontaneously.

Front 29

After a baby's lungs are ventilated, if blood and tissue oxygen levels are low, cardiac output may have to be assisted by what?

Back 29

If blood and tissue oxygen levels are low, cardiac output may have to be assisted by chest compressions and epinephrine (Blocks C and D) for blood to reach the lungs to pick up oxygen.

Front 30

Although you w ill use all 3 signs simultaneously (respirations, heart rate, and color), one is most important for determining whether you should proceed to the next step. what is it?

Back 30

Although you will evaluate all 3 signs simultaneously, a seriously low heart rate is most important for determining whether you should proceed to the next step.

Front 31

Every delivery should be attended by at least how many skilled person(s) whose only responsibility is the management of the newborn?

Back 31

At every delivery, there should be at least 1 person who can be immediately available to the baby as his or her only responsibility and who is capable of initiating resuscitation.

Front 32

If a high-risk delivery is anticipated, at least how many skilled person(s) whose only responsibility is resuscitation and the management of the baby, should be present at the delivery?

Back 32

If the delivery is anticipated to be high risk, and thus may require more advanced neonatal resuscitation, at least 2 persons should be present solely to manage the baby, 1 with complete resuscitation skills and 1 or more to assist.

Front 33

When a depressed newborn is anticipated at a delivery, resuscitation equipment (should) (should not) be unpacked and ready for use.

Back 33

when a high-risk newborn is expected, appropriate equipment should be ready to use.

Front 34

A baby who was meconium stained andnot vigorous at birth had meconium suctioned from the trachea. She then resumed breathing and became more active. This baby should now received (routine) (observational) (post-resuscitation) care.

Back 34

Babies who have perinatal or intrapartum risk factors, have meconium staining of the amniotic fluid or skin, have depressed breathing or activity, and/or are cyanotic will need closer assessment. This baby should receive observational care.

Front 35

As summarized in the Key Points, The 4 steps of neonatal resuscitation are:

Back 35

1. Initial steps: provide warmth, position head and clear airway as necessary, dry and stimulate baby to breathe, evaluate respirations, heart rate, and color.
2. Provide positive-pressure ventilation with a resuscitation bag and supplemental oxygen.
3. Provide chest compressions as you continue assisted ventilation.
4. Administer epinephrine as you continue assisted ventilation and chest compressions.

Front 36

Lesson 1 Review:
About what percent of newborns will require some assistance to begin regular breathing?

Back 36

About 10% of newborns will require some assistance to begin regular breathing.

Front 37

About what percent of newborns will require extensive resuscitation to survive?

Back 37

About 1% of newborns will require extensive resuscitation to survive.

Front 38

Chest compressions and medications are (rarely) (frequently) needed when resuscitating newborns.

Back 38

Chest compressions and medications are rarely needed when resuscitating newborns.

Front 39

Before birth, the alveoli in a baby's lungs are (collapsed) (expanded) and filled with (fluid) (air).

Back 39

Before birth, the alveoli in a baby's lungs are expanded and filled with fluid.

Front 40

The air that fills the baby's alveoli during normal transition contains what percent oxygen?

Back 40

The air that fills the baby's alveoli during normal transition contains 21% oxygen.

Front 41

Lesson 1 Review:
The oxygen in the baby's lungs then causes the pulmonary arterioles to (relax) (constrict) so that the oxygen can be absorbed from the alveoli and distributed to all organs.

Back 41

The oxygen in the baby's lungs then causes the pulmonary arterioles to relax so that the oxygen can be absorbed from the alveoli and distributed to all organs.

Front 42

Lesson 1 Review:
If a baby does not begin breathing in response to stimulation, you should assume he is in which apnea and you should provide what?

Back 42

If a baby does not begin breathing in response to stimulation, you should assume he is in secondary apnea and you should provide positive-pressure ventilation.

Front 43

Lesson 1 Review:
If a baby is deprived of oxygen and enters the stage of secondary apnea, his heart rate will (rise) (fall), and his blood pressure will (rise) (fall).

Back 43

If a baby is deprived of oxygen and he enters the stage of secondary apnea, his heart rate will fall, and his blood pressure will fall.

Front 44

Lesson 1 Review:
Restoration of adequate ventilation usually results in a (rapid) (gradual) (slow) improvement in heart rate.

Back 44

Restoration of adequate ventilation usually results in a rapid improvement in heart rate.

Front 45

Lesson 1 Review:
A heart rate of less than what indicates a need for positive-pressure ventilation

Back 45

A heart rate of less than 100 bpm indicates a need for positive-pressure ventilation.

Front 46

Lesson 1 Review:
A heart rate of less than 100 bpm indicates a need for what?

Back 46

A heart rate of less than 100 bpm indicates a need for positive-pressure ventilation.

Front 47

Lesson 1 Review:
A heart rate of less than what indicates a need for positive-pressure ventilation and chest compressions?

Back 47

A heart rate of less than 60 indicates a need for positive-pressure ventilation and chest compressions.

Front 48

Lesson 1 Review:
A heart rate of less than 60 bpm indicates a need for what?

Back 48

A heart rate of less than 60 bpm indicates a need for positive-pressure ventilation and chest compressions.

Front 49

Lesson 1 Review:
After 30 seconds of positive-pressure ventilation and chest compression, a heart rate below what indicates a need for the administration of epinephrine?

Back 49

After 30 seconds of positive-pressure ventilation and chest compressions, a heart rate below 60 bpm indicates a need for the administration of epinephrine.

Front 50

Lesson 1 Review:
Resuscitation (should) (should not) be delayed until the 1-minute Apgar score is available.

Back 50

Resuscitation should not be delayed until the 1-minute Apgar score is available.

Front 51

Lesson 1 Review:
premature babies may present unique challenges during resuscitation because of what 4 factors?

Back 51

Premature babies have fragile brain capillaries, immature lungs, poor temperature control, and are more likely to have an infection.

Front 52

Lesson 1 Review:
every delivery should be attended by at least how many skilled person(s) whose only responsibility is the management of the newborn?

Back 52

Every delivery should be attended by at least 1 skilled person.

Front 53

Lesson 1 Review:
If a high-risk delivery is anticipated, at least how many skilled person(s), whose only responsibility is resuscitation and the management of the baby, should be present at the delivery?

Back 53

At least 2 skilled persons should be present at a high-risk delivery.

Front 54

lesson 1 Review:
When a depressed newborn is anticipated at a delivery, resuscitation equipment (should) (should not) be unpacked and ready for use.

Back 54

Equipment should be unpacked if a newborn is anticipated to be depressed at delivery.

Front 55

Lesson 1 Review:
A baby who was meconium stained and not vigorous at birth had meconium suctioned from the trachea. She then resumed breathing and became more active. this baby should now receive (routine) (observational) (post-resuscitation) care.

Back 55

since the baby required suctioning of meconium from the airway, she should receive observational care.

Front 56

Lesson 2:
A newborn who is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone (does) (does not) need resuscitation.

Back 56

A newborn who is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone does not need resuscitation.

Front 57

Lesson 2:
A newborn with meconium in the amniotic fluid and who is not vigorous (will) (will not) need to have a laryngoscope inserted and be suctioned with an endotracheal tube. A newborn with meconium in the amniotic fluid and who is vigorous (will) (will not) need to have a laryngoscope inserted and be suctioned with an endotracheal tube.

Back 57

A newborn with meconium in the amniotic fluid and who is not vigorous will need to have a laryngosope inserted and be suctioned with an endotracheal tube. A newborn with meconium in the amniotic fluid and who is vigorous will not need to have a laryngoscope inserted and be suctioned with an endotracheal tube.

Front 58

Lesson 2:
When deciding which babies need tracheal suctioning, the term "vigorous" is defined by what 3 characteristics?

Back 58

Vigorous is defined as strong respiratory efforts, good muscle tone, and a heart rate greater than 100 bpm.

Front 59

Lesson 2:
When a suction catheter is used to clear the oropharynx of meconium before inserting an endotracheal tube, the appropriate size is what or what?

Back 59

Insert a laryngoscope and use a 12F or 14F suction catheter to clear the mouth and posterior pharynx so that you can visualize the glottis.

Front 60

Lesson 2:
A newborn is covered with meconium, is breathing well, has normal muscle tone, has a heart rate of 120 bpm, and is pink. The correct action is what?

Back 60

The correct action is to suction the mouth and nose with a bulb syringe or suction catheter.

Front 61

Lesson 2:
In suctioning baby's nose and mouth, the rule is to first suction the what and then the what?

Back 61

In suctioning a baby's nose and mouth, the rule is to first suction the mouth and then the nose.

Front 62

Lesson 2:
After drying and suctioning what are the two safe and appropriate methods of providing additional tactile stimulation?

Back 62

After drying and suctioning, safe and appropriate methods of providing additional tactile stimulation include slapping or flicking the soles of the feet and gently rubbing the newborn's back, trunk, or extremities.

Front 63

Lesson 2:
If a baby is in secondary apnea, stimulation alone (will) (will not) stimulate breathing.

Back 63

If a baby is in secondary apnea, stimulation alone will not stimulate breathing.

Front 64

Lesson 2:
A newborn is still not breathing after a few seconds of stimulation. the next action should be to administer what?

Back 64

The next action is to administer positive-pressure ventilation.

Front 65

Lesson 2:
A newborn is breathing and cyanotic. what are your initial steps:

Back 65

For a newborn who is breathing and cyanotic, your initial steps are to place the newborn on a radiant warmer, suction his mouth and nose, dry and stimulate, remove all wet linen, and give free-flow oxygen

Front 66

Lesson 2:
What 3 ways are correct for giving free-flow oxygen to a baby who is cyanotic but is breathing well?

Back 66

The 3 correct ways for giving free-flow oxygen to a baby who is cyanotic but breathing well are an oxygen mask held firmly over the baby's face, the mask from a flow-inflating bag or t-piece resuscitator held closely over the baby's mouth and nose, and oxygen tubing cupped closely over the baby's mouth and nose.

Front 67

Lesson 2 Review:
A newborn who is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone (does) (does not) need resuscitation.

Back 67

A newborn who is born at term, has no meconium in the amniotic fluid or on the skin, is breathing well, and has good muscle tone does not need resuscitation.

Front 68

Lesson 2 Review:
A newborn with meconium in the amniotic fluid and who is not vigorous (will) (will not) need to have a laryngoscope inserted and be suctioned with an endotracheal tube.
A newborn with meconium in the amniotic fluid and who is vigorous (will) (will not) need to have a laryngoscope inserted and be suctioned with an endotracheal tube.

Back 68

A newborn with meconium in the amniotic fluid and who is not vigorous will need to have a laryngoscope inserted and be suctioned with an endotracheal tube

A newborn with meconium in the amniotic fluid and who is vigorous will not need to have a laryngoscope inserted and be suctioned with an endotracheal tube.

Front 69

Lesson 2 Review:
When deciding which babies need tracheal suctioning, the term "vigorous" is defined by what 3 characteristics?

Back 69

Vigorous is defined as strong respirator efforts, good muscle tone, and a heart rate greater than 100 bpm.

Front 70

Lesson 2 Review:
when a suction cater is used to clear the oropharynx of meconium before inserting an endotracheal tube what are the appropriate sizes?

Back 70

12 or 14 French are the appropriate sizes.