Case studies in Neonatal CPR via AHI 2005 Guidelines

Case studies in Neonatal CPRvia AHI 2005 Guidelines By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP Kingwood College Respiratory Care Department Kingwood College Kingwood, Texas

Question: Case # 1 • Your baby is 20 week gestation by dates and by exam. • His weight is 350 grams • He is born with APGAR's of 3 . • Is he a candidate for CPR?

answer • No, he is too small to be considered viable

Question: Case study # 2 • Your patient is 24 week’s gestation by dates. • She is flaccid and breathing is irregular & she doesn’t respond to tactile stimulation while you dry her off. • Is CRP indicated?

answer • Yes, she is premature • Her breathing is irregular • & she has poor muscle tone

Question • What else do you need to know about this infant?

answer • Is the amniotic fluid cloudy or clear? • Is the HR above 100 bpm? • Is the baby centrally cyanotic?

Question • The baby’s HR is 120 bpm and her lips are cyanotic. • What do you do now?

answer • Dry her off • Bulb suction her if she needs it • Place her in the sniff position. • Blow 02 and • Reassess her for better skin color & regular RR .

question You are blowing 02 to her face at 5 lpm. Her HR is 125 bpm Her RR is 75 bpm with retractions Her lips are pink after a minute on 02 blow-by • What do you want to do now?

answer • Place her under a hood • Get a pulse-oximeter on her to titrate the Fi02 • Reassess her because we are concerned about her being flaccid.

Question: Case study # 3 Your patient is a 27-week gestation, infant who is about 1500 grams What else do you need to know about this infant?

answer • Is the baby crying? • Does the baby have good muscle tone? • Is the amniotic fluid clear?

Question • When you assess this infant for these items you note that the baby’s HR is 55 bpm, the respiratory rate is 15 bpm and the baby is flaccid. • What do you do at this point?

answer Dry her off, establish an airway and mask bag at 40-60 bpm Reassess in 30 seconds

Question • After 30 seconds, the HR is at 54 bpm, the patient is centrally cyanotic even with bagging with Fi02 100% at a rate of 50 bpm. • What do you want to do?

answer • Observe the chest for good chest movement • Listen to the BBS for good bagging • Intubate now & • Start compressions at a HR of 90 bpm

question You are bagging at 30 bpm, the chest is rising & The nurse is doing chest compressions at 90 bpm • What is the ratio of compressions to RR?

answer • 1:3

question • After 30 seconds of chest compression, and bagging, you recommend what?

answer • Reassess HR and RR, Sp02 and skin color

question • How far do we compress the chest during CPR?

Answer: • 1/3 to ½ the depth of the chest wall

question • The HR is 45 bpm • The Sp02 is 76% on Fi02 100% • There is a 3.0 endotracheal tube down to # 10 and you hear BBS with bagging. • There are no spontaneous breathing efforts & the skin is mottled • What do you suggest we do at this time?

answer • Continue to do compressions and bagging with 02 • Reassess in 30 seconds • If no response, give IV epinephrine • Continue compressions, bagging and reassess in 30 seconds • Check glucose levels and if low give glucose • Give volume expanders if hypotensive • Perform CPR for 10 minutes before stopping

Question: Case study # 4 • Your patient is a 35 week by gestation by dates. His mom has gestational diabetes. He has a APGAR of 6 at 1 minute & 7 at 5 minutes • His RR is 65 bpm with minimal retractions, no flaring • His HR is 135 bpm • He is placed under a croup tent at 40% and his Sp02 rises from 88% to 91% • After 10 minutes, you note that his Sp02 has dropped to 85% and that his skin is mottled and he is breathing irregularly What has happened?

answer • He is cold-stressed, which has increased his 02 consumption and lowered his glucose levels.

question • What do you want to do?

answer • Increase his Fi02 • Reassess Sp02 and his respiratory rate • Mask bag if his RR is still irregular • Get his temperature & place him under a heated hood to raise his body temperature • Get a serum glucose and replace the glucose he’s used up

Case studies in Neonatal CPR via AHI 2005 Guidelines