Lesson 2 Initial Steps In Resuscitation

Front 1

After the birth what 4 questions will you be asking yourself in order to decide if baby needs resuscitation?

Back 1

Is the baby TERM gestation?
Clear amniotic fluid?
Breathing or crying?
Good Muscle tone?

Front 2

What are the initial steps and how are they administered?

Back 2

once you decide that resuscitation is required, all the initial steps should be initiated within a few seconds

provide warmth- radiant warmer, remove blankets
position by slightly extending the neck- baby should be positioned on back with neck slightly extended in the sniffing position
clear airway- suction mouth and trachea if MECONIUM is present and baby is NOT vigorous

Front 3

How is Vigorous defined?

Back 3

Vigorous is defined by a strong respiratory effort, good muscle tone and heart rate greater than 100bpm

Front 4

What do you do if meconium is present and the baby is NOT vigorous?

Back 4

direct suctioning of the trachea soon after delivery is indicated. USE A 12F or 14F suction catheter to clear the mouth and posterior pharynx so you can visualize the glottis
insert endotracheal tube into trachea
attach endotracheal tube to the suction source
apply suction as tube is withdrawn

Front 5

What do you do if MEC is present and the baby IS VIGOROUS?

Back 5

Clear secretions from mouth

Front 6

A newborn who is born TERM, with NO MECONIUM, is breathing well and has good muscle tone does or does not need resuscitation?

Back 6

DOES NOT

Front 7

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

Back 7

This baby WILL need to have the laryngoscope inserted and suctioned with an endotracheal tube

Front 8

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

Back 8

good muscle tone
heart rate of 100 and above
strong respiration efforst

Front 9

what size of suction catheter is used to clear the oropharynx of meconium before inserting an endotraceal tube?

Back 9

YOU will want a 12F or a 14F

Front 10

When using the suction from the wall or from the pump, the suction pressure should be set so that when the tube is pinched the negative pressure should read?

Back 10

100 mm Hg

Front 11

what do you suction on the baby first?

Back 11

MOUTH first
then NOSE

Front 12

Once the airway is cleared, what should be done to prevent further heat loss and to stimulate breathing

Back 12

dry baby thoroughly
remove wet linen
reposition head in a sniffing position to maintain good airway

Front 13

What other forms of stimulation may help a baby to breathe?

Back 13

slapping or flicking soles of feet
gently rubbing newborns back, trunk or extremeties
NEVER SHAKE A BABY

Front 14

If baby is in secondary apnea, stimulation alone will or will not stimulate breathing?

Back 14

WILL NOT

Front 15

Your newborn is still not breathing after a few seconds of stimulation. The next action should be administered, what are you going to do?

Back 15

Positive- pressure ventilation

Front 16

Now that you have warmed, positioned, cleared the airway dried, stimulated and repositioned the baby's head, what do you do next?

Back 16

Evaluate the baby to determine if further resuscitation is needed
check the respirations- there should be good chest movement and the rate and depth should increase after few seconds of tactile stimulation

Front 17

what should the heart rate be?

Back 17

ABOVE 100

Front 18

how can you count the heart rate quickly?

Back 18

count for 6 sec. and then ties by 10

so if in 6 seconds you got 5 then you would 5 x 10 = 50

Front 19

what do you do if respirations or heart rate are abnormal?

Back 19

give supplemental oxygen and consider PPV ( positive pressure ventilation)

Front 20

What do you do if the baby is breathing but has central cyanosis?

Back 20

Cyanosis is caused by too little oxygen. PROVIDE supplemental oxygen

Front 21

At what concentration should the oxygen be flowing?

Back 21

for newborn 5 L/minute

Front 22

If baby requires supplemental oxygen, how should it be given?

Back 22

using free- flow at 5 L/ Minute

Front 23

How do you know when to stop giving oxygen?

Back 23

when the newborn no longer has central cyanosis, gradually withdrawl the supplemental oxygen until the newborn can remain pink while breathing room air

Front 24

You have stimulated a newborn and suctioned her mouth. It is now 30 seconds after birth and she is still apneic and pale. Her heart rate is 80 beats per minutes your next step is to?

Back 24

START providing Positive pressure ventilation