1 / 36

Review NRP part II

Review NRP part II. Lone Star college systems: Kingwood Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP. Exactly how do we mask bag a newborn?. We select a mask that fits over the nose and mouth without fitting over the eyes We make sure the airway is clear

eshana
Download Presentation

Review NRP part II

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Review NRP part II Lone Star college systems: Kingwood Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

  2. Exactly how do we mask bag a newborn?

  3. We select a mask that fits over the nose and mouth without fitting over the eyes • We make sure the airway is clear • We position the baby’s head in the sniffing position • Use less than 30cmH20 pressure to inflate • Deliver 40-60 BPM breath…2…3…breath…2…3… answer

  4. How do you know your bagging is effective?

  5. With in 30 seconds • see & feel the chest rise • Have someone listen to the BBS • Monitor the patient’s HR which should rise as the baby gets good ventilation • Observe the skin color get pinker • And the baby’s muscle tone improve answer

  6. What if these good results fail to happen within 30 seconds?

  7. Reassess the seal around mask • Re-establish head position • Increase PIP till you see chest rising • If these don’t work, orally intubate • Check that the 02 line has not come off the bag or that the flow meter has not been turned off • Is the belly getting full of air? answer

  8. If you will have to mask bag for more than a few minutes what hazards need to be avoided?

  9. Gastric insufflations: get an 8 French feeding tube tube into the baby • Poor seal: monitor head position and mask position answer

  10. How long should the feeding tube be?

  11. Without interrupting mask bagging, measure from bridge of nose to ear lobe and then to midway between the xyphoid process and the naval. • Note the cm mark at this point • Insert tube through the mouth & aspirate stomach contents with syringe • Remove syringe so gas can be vented from belly answer

  12. When do we start compressions on the newborn

  13. When the baby’s HR is less than 60 BPM after 30 seconds of effective ventilations, we start compressions at 90 BPM • If the HR is above 60 BPM, we continue to mask bag until the HR gets above 100 BPM; if the patient is still apneic, intubate answer

  14. What is the function of the pressure gauge on the self-inflating manual resuscitator? • What is the function of the reservoir on the back of the bag?

  15. pressure gauge helps you determine the PIP being used to inflate the lung • A properly-sized reservoir on the back of the bag helps raise the Fi02 of the bag to close to 90- 100% answer

  16. What is the Fi02 of the self-inflating manual resuscitator without the reservoir?

  17. It is only 40% answer

  18. How do you prepare the T-piece resuscitator?

  19. Go here to view picture • http://perinatalcyprus.com/video/video.php?video=22&PHPSESSID=e17cb7b0bb4e3a2ba9ca39754a39d3b9 • Set 5-15 LPM from blender or 02 flowmeter • Set max pressure at 40 cmH20 [on dial on the left of page. Keep finger over PEEP cap • Set PIP on right-sided dial; keep finger over PEEP cap • Set the PEEP by removing finger from PEEP cap and adjusting level between zero to 5 cmH20 on the top of the cap itself answer

  20. How do you perform chest compressions in the newborn

  21. Draw a line between the nipples and place hands just below this line on lower 1/3rd of sternum • Thumb method: encircle the chest, fingers support the spine • Two finger method: compress • Depress 1/3rd of the AP diameter of chest answer

  22. While doing compressions on the newborn do you spend more time going down or coming up?

  23. The duration of the downward stroke needs to be slightly shorter than the upward stroke answer

  24. What is the rhythm of chest compressions?

  25. One- and- two- and- three- and bag • There should be 90 compressions/minute with 30 breaths • Do this for 30 seconds before reassessing HR with palpation of umbilical cord answer

  26. What do you do if the compressions are not having an effect

  27. Reassess pulse in 30 seconds • If there is no pulse rate above 60 , give epinephrine answer

  28. What is the route and the dose of epinephrine in the newborn without a pulse

  29. Give via Umbilical Venous Catheter • Give 1:10,000 by IV • Give .1 mL /kg to .3 mL/kg • If instillation down ET tube • Raise dose to .3 mL/kg to 1 ml/kg answer

  30. Your baby is 1500 gram. How much epinephrine should she get by IV?

  31. .1 x 1.5 kg = .15 ml of 1:10,000 epinephrine • .3 x 1.5 kg = .45 ml of 1:10,000 epinephrine answer

  32. What do you do if your patient has been intubated sucessfuly, you’ve bagged effectively, and given epinephrine, but your babies HR is still less than 60 BPM

  33. Continue CPR • Continue bagging; reassess BBS and chest rising • If there is a history of bleeding or patient appears shocky—administer volume expanders answer

  34. You have been bagging sucessully, now you see that the chest is no longer rising & you have breath sounds only on one side. • What do you do?

  35. Assess the infant for possible pneumothorax • Needle aspiration of the chest wall over the area of no BS answer

  36. The end

More Related