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. answer 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…

4. How do you know your bagging is effective?

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

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

7. answer 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?

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

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

10. How long should the feeding tube be?

11. answer 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

12. When do we start compressions on the newborn

13. answer 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

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. answer 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%

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

17. answer It is only 40%

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

19. answer Go here to view picture http://perinatalcyprus.com/video/video.php?vide o=22&PHPSESSID=e17cb7b0bb4e3a2ba9ca3975 4a39d3b9 http://perinatalcyprus.com/video/video.php?vide o=22&PHPSESSID=e17cb7b0bb4e3a2ba9ca3975 4a39d3b9 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

20. How do you perform chest compressions in the newborn

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

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

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

24. What is the rhythm of chest compressions?

25. answer 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

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

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

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

29. answer 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

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

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

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

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

36. The end