Neonatal Resuscitation Algorithm Flashcard 4
Rationale
D. Rationale: NRP guidelines recommend a compression to ventilation ratio of 3:1 with synchronized breaths.
Question
What is the chest compression to ventilation ratio for an intubated non vigorous newly born when chest compressions are necessary for neonatal resuscitation?
a. 30 compressions to 2 ventilations
b. 15 compressions to 2 ventilations
c. 5 compressions to 1 ventilation
d. 3 compressions to 1 ventilation
Answer
d. 3 compressions to 1 ventilation
Rationale
C. Rationale: NRP recommends that chest compressions be given at a depth of 1/3 of the anterior-posterior diameter of the chest.
Question
What is the correct depth of chest compressions?
a. 1/4 of the anterior-posterior diameter of the chest
b. 1/2 of the anterior-posterior diameter of the chest
c. 1/3 of the anterior-posterior diameter of the chest
d. 2 inches
Answer
c. 1/3 of the anterior-posterior diameter of the chest
Rationale
A. Rationale: Preductal SpO2 via pulse oximeter placed on the right upper extremity can indicate the oxygen saturation status of a newborn and the possibility that the transition to neonatal circulation is compromised. The normal preductal SpO2 of a newborn 1 minute after birth is 60–65%.
Question
What is the expected preductal SpO2 of a newborn 1 minute after birth?
a. 60–65%
b. 65–70%
c. 80–85%
d. 85–95%
Answer
a. 60–65%
Rationale
A. Rationale: The initial steps in newborn resuscitation be performed within 1 minute after birth.
Question
What is the expected timeframe for performing he initial steps in newborn resuscitation?
a. 1 minute
b. 2 minutes
c. 3 minutes
d. 5 minutes
Answer
a. 1 minute
Rationale
A. Rationale: Volume expanders, such as crystalloid fluids or RBCs, should be administered at a dose of 10 mL/kg for newborns in hypovolemic shock.
Question
What is the recommended dose of intravenous fluid to give when resuscitating newborns in hypovolemic shock?
a. 10 mL/kg
b. 20 mL/kg
c. 30 mL/kg
d. 40 mL/kg
Answer
a. 10 mL/kg
Rationale
A. Rationale: Titrate the oxygen concentration to match the targeted preductal oxygen saturation, which varies per minute after birth. At sea level, initially set the percentage of oxygen at 21% (room air) for all term newborns.
Question
When initially providing oxygen supplementation to term newborns at sea level, what percentage of oxygen should the team use?
a. 21%
b. 45%
c. 50%
d. 100%
Answer
a. 21%
Rationale
B. Rationale: Newly born patients in need of resuscitation rarely have an underlying cardiac problem. Quality positive pressure ventilation and compressions take priority over epinephrine. Thus, epinephrine is only considered when the baby fails to improve after adequate ventilation and high quality chest compressions.
Question
When is epinephrine considered as a treatment in neonatal resuscitation?
a. Immediately after the neonate’s heart rate goes below 60 bpm
b. When the newly born remains bradycardic after adequate positive pressure ventilation and chest compressions
c. After 5 cycles of high-quality CPR, and the neonate fails to achieve a return of spontaneous circulation
d. After 1 minute of high-quality CPR, regardless of the heart rate
Answer
b. When the newly born remains bradycardic after adequate positive pressure ventilation and chest compressions
Rationale
D. Rationale: The newly born’s heart rate is considered the most sensitive indicator of a successful response to each intervention. An increase in heart rate denotes successful positive pressure ventilation.
Question
Which finding best represents adequate positive pressure ventilation in a newly born in need of neonatal resuscitation?
a. An increase in blood pressure
b. An increase in respiratory rate
c. A decrease in end-tidal CO2
d. An increase in heart rate
Answer
d. An increase in heart rate
Rationale
D. Rationale: Adequate ventilation is evidenced by a visible chest rise after providing each breath. The presence of resistance during each ventilation indicates an obstruction. When the CO2 detector is colored purple, the endotracheal tube may be misplaced. The estimated preductal oxygen saturation at 2 minutes is 65–70%.
Question
Which finding confirms that you are providing adequate ventilation, which can be a deciding point for initiating chest compression?
a. There is resistance in the self-inflating bag during each breath.
b. The CO2 detector is colored purple.
c. Preductal oxygen saturation reads 60% at 2 minutes after delivery.
d. There is a visible chest rise after each breath provided.
Answer
d. There is a visible chest rise after each breath provided.
Rationale
A. Rationale: An advanced airway is recommended. If the baby’s heart rate does not improve after giving effective positive pressure ventilation or if effective positive pressure ventilation is not achieved after troubleshooting. Choice B is incorrect because CPAP is recommended when a baby fails to achieve a preductal oxygen saturation within the predicted levels, but has a heart rate of 100 bpm. Choice C is incorrect because acrocyanosis is a normal finding in newly born patients. Additional symptoms such as bradycardia must be present with acrocyanosis to consider the placement of an advanced airway.
Question
Which of the following are conditions for applying an alternative airway in a newly born?
a. When the heart rate does not increase after a significant time of positive pressure ventilation
b. When the neonate fails to demonstrate the predicted preductal oxygen saturation within normal limits and has a heart rate of 100 bpm
c. In the presence of acrocyanosis
d. All of the above
Answer
a. When the heart rate does not increase after a significant time of positive pressure ventilation