Review NRP part IIReview NRP part IILone Star college systems: Kingwood

Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

Exactly how do we mask bag a newborn?

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We select a mask that fits over the nose and mouth without fitting over the eyes

We make sure the airway is clearWe position the baby’s head in the sniffing

positionUse less than 30cmH20 pressure to inflateDeliver 40-60 BPM breath…2…3…breath…

2…3…

How do you know your bagging is effective?

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With in 30 secondsa. see & feel the chest riseb. Have someone listen to the BBSc. Monitor the patient’s HR which should rise as

the baby gets good ventilationd. Observe the skin color get pinkere. And the baby’s muscle tone improve

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

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Reassess the seal around maskRe-establish head positionIncrease PIP till you see chest risingIf these don’t work, orally intubateCheck 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?

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

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Gastric insufflations: get an 8 French feeding tube tube into the baby

Poor seal: monitor head position and mask position

How long should the feeding tube be?

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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 pointInsert tube through the mouth & aspirate

stomach contents with syringeRemove syringe so gas can be vented

from belly

When do we start compressions on the newborn

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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

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?

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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%

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

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It is only 40%

How do you prepare the T-piece resuscitator?

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Go here to view picturehttp://perinatalcyprus.com/video/video.php?video

=22&PHPSESSID=e17cb7b0bb4e3a2ba9ca39754a39d3b9

Set 5-15 LPM from blender or 02 flowmeterSet max pressure at 40 cmH20 [on dial on the

left of page. Keep finger over PEEP capSet PIP on right-sided dial; keep finger over PEEP

capSet the PEEP by removing finger from PEEP cap

and adjusting level between zero to 5 cmH20 on the top of the cap itself

How do you perform chest compressions in the newborn

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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

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

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

What is the rhythm of chest compressions?

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One- and- two- and- three- and bagThere should be 90 compressions/minute

with 30 breathsDo this for 30 seconds before reassessing

HR with palpation of umbilical cord

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

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Reassess pulse in 30 secondsIf there is no pulse rate above 60 , give

epinephrine

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

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Give via Umbilical Venous CatheterGive 1:10,000 by IVGive .1 mL /kg to .3 mL/kgIf instillation down ET tubeRaise dose to .3 mL/kg to 1 ml/kg

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

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.1 x 1.5 kg = .15 ml of 1:10,000 epinephrine

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

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

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Continue CPRContinue bagging; reassess BBS and chest

risingIf there is a history of bleeding or patient

appears shocky—administer volume expanders

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?

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Assess the infant for possible pneumothorax

Needle aspiration of the chest wall over the area of no BS

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