Positive Pressure Ventilation Flashcard 1
Rationale
B. Rationale: Transillumination of the chest is done with a fiberoptic light source in a dark room. The chest wall side with the brightest transillumination is the side with the pneumothorax.
Question
You are performing a transillumination test to detect a pneumothorax in a preterm newborn. Which of the following is a diagnostic finding of a pneumothorax?
a. The chest wall side with the darkest illumination is the side with the pneumothorax.
b. The chest wall side with the brightest illumination is the side with the pneumothorax.
c. A pneumothorax demonstrates a homogenous illumination on both sides of the chest.
d. A pneumothorax demonstrates a total blackout on both sides of the chest.
Answer
b. The chest wall side with the brightest illumination is the side with the pneumothorax.
Rationale
C. Rationale: If the preterm has spontaneous breathing with a heart rate of at least 100 bpm but has labored breathing and low oxygen saturation levels, then CPAP is recommended. Studies have shown that the early use of CPAP reduces the need for intubation and mechanical ventilation.
Question
A preterm newly born is brought to the neonatal ICU. She has a heart rate of 130 bpm, but her breathing is labored. Oxygen saturation can only be maintained to 90%. Which one of the following interventions is best to help improve the newborn’s condition?
a. Administration of exogenous surfactant
b. Intravenous infusion of dopamine
c. Continuous positive airway pressure
d. Endotracheal intubation with mechanical ventilation
Answer
c. Continuous positive airway pressure
Rationale
B. Rationale: Rationale: The pop-off valve ensures that the pressure given to the patient during assisted ventilation does not exceed a certain limit to prevent barotrauma.
Question
A self-inflating bag has a built-in mechanism to prevent the pressure given to the patient from exceeding 30–40 cm H2O. What is this device called?
a. PEEP valve
b. Pop-off valve
c. One-way valve
d. High-pressure valve
Answer
b. Pop-off valve
Rationale
A. Rationale: On administering PPV in intubated patients or via resuscitation facemask, the PPV inflation pressure must be as low as possible to maintain the preterm baby’s heart rate > 100 bpm. The heart rate is the best indicator that the baby is improving.
Question
After neonatal resuscitation, a preterm newly born is intubated on a mechanical ventilator and receiving positive pressure ventilation. When monitoring the patient, which of the following is the best indicator of a good response to the management?
a. Heart rate is > 100 bpm
b. Oxygen saturation is between 94% and 100%
c. The preterm newborn is active
d. The preterm newborn is pink
Answer
a. Heart rate is > 100 bpm
Rationale
A. Rationale: If there is still no visible chest rise even after performing the troubleshooting steps for positive pressure ventilation, you must assume there is not enough air pressure to increase lung compliance. Therefore, continue to increase the peak inspiratory pressure gradually in increments of 5 to 10 cm H2O.
Question
After troubleshooting inadequate positive pressure ventilation, you still have not observed a visible chest rise. What can you conclude at this point?
a. The peak inspiratory pressure must be increased by 5 to 10 cm H2O.
b. The newborn must be intubated and connected to a mechanical ventilation machine.
c. Establish intravenous access and give IV epinephrine.
d. Be ready to intubate the patient.
Answer
a. The peak inspiratory pressure must be increased by 5 to 10 cm H2O.
Rationale
D. Rationale: The most important intervention in neonatal resuscitation for a non vigorous newly born is providing assisted ventilation. The most common cause of cardiac arrest in this type of patient is respiratory rather than cardiac in origin. Respiratory failure is more common during the transition from fetal circulation to pulmonary circulation.
Question
During neonatal resuscitation, which of the following interventions is the most important and effective?
a. Chest compressions
b Medications
c. Defibrillation
d. Ventilation
Answer
d. Ventilation
Rationale
C. Rationale: The preresuscitation team briefing prepares the neonatal resuscitation team. It includes assessing the perinatal risk factors, identification of a team leader, delegating a single task to each team member to avoid confusion, assigning a person to document all of the events as they occur, choosing what supplies or equipment to use, and assigning a specialist in case of a complicated birth beyond the expertise of the team.
Question
Healthcare institutions provide protocols to safeguard the birth of a high-risk infant while the mother is still in labor, one of which is known as a preresuscitation team briefing. Which of the following plays a role in the preresuscitation team briefing?
a. Choosing two team leaders
b. Assigning multiple tasks to team members
c. Assessing perinatal risk factors
d. All of the above
Answer
c. Assessing perinatal risk factors
Rationale
B. Rationale: Repositioning is the second action to be done when troubleshooting an ineffective positive pressure ventilation situation (remember the mnemonic MR. SOPA). The sniffing position may involve placing a towel just behind the baby’s shoulders to keep the airway patent.
Question
Repositioning a newborn to achieve a patent airway is done by performing which of the following actions?
a. Removing the mask and reapplying it to the baby’s face
b. Adjusting the baby’s head to maintain a sniffing position
c. Tilting the head back so that the neck is hyperextended
d. Opening the baby’s mouth
Answer
b. Adjusting the baby’s head to maintain a sniffing position
Rationale
D. Rationale: The major downside of this instrument is that it was not designed for suctioning secretions from the airway. The seal surrounding the air mask may leak when increased ventilation pressure is needed. And lastly, laryngeal masks cannot be used in small newborns < 2,000 grams.
Question
The major disadvantages of using a laryngeal mask include:
a. It is not designed for suctioning secretions.
b. The seal surrounding the mask often leaks when ventilation pressure is increased.
c. It cannot be used for small newborns.
d. All of the above
Answer
d. All of the above
Rationale
B. Rationale: The T-piece resuscitator has a dial on the cap that can be turned clockwise and counter-clockwise to decrease or increase the PEEP accordingly.
Question
The PEEP can be adjusted using a T-piece resuscitator by:
a. Increasing the oxygen flow rate
b. Turning the dial on the T-piece cap
c. Occluding the gas-escape opening on the T-piece cap
d. Increasing or decreasing the compressed air pressure
Answer
b. Turning the dial on the T-piece cap