NRP key points/study questions

What phrase is used to achieve the correct rhythm for coordinating compressions and ventilation?

"One-and-Two-and-Three-and-Breathe-And"

Using the correct concentration of epinephrine, the recommended intravenous dose is (0.1 to 0.3 ml/kg)/ (0.5 to 1 mL/kg)

0.1 to 0.3 mL/kg

What happens during a pre-resuscitation team briefing? (6)

1- Assess perinatal risk factors 2- Identify a team leader 3- Delegate tasks 4- Identify who will document events as they occur 5- Determine what supplies and equipment will be needed 6- Identify how to call for additional help

If a baby's condition worsens after endotracheal intubation, list the 4 possible causes. ("DOPE")

1- Displaced endotracheal tube 2- Obstructed endotracheal tube 3- Pneumothorax 4- Equipment failure

What are the primary methods of confirming endotracheal tube placement within the trachea? (2)

1- demonstrating exhaled Co2 (detector turns yellow) AND 2- observing a rapidly increasing heart rate

After completing the initial steps, PPV is indicated if..... (3)

1- if the baby is not breathing (apneic) OR 2- if the baby is gasping OR 3- if the baby's heart rate is less than 100bpm

List the 3 rapid evaluation questions that determine which newborns should be brought to the radiant warmer for the initial steps.

1. Is the baby term? 2. Does the baby have good tone? 3. Is the baby breathing or crying?

List the 5 initial steps in newborn care.

1. Provide warmth 2. Position the head and neck to open the airway 3. Clear secretions from the airway if necessary 4. Dry 5. Stimulate

What are the 4 pre-birth questions to ask the obstetric provider before birth?

1. What is the expected gestational age? 2. Is the amniotic fluid clear? 3. How many babies are expected? 4. Are there any additional risk factors?

A healthy newborn breathing room air may take more than ______ minutes to achieve oxygen saturation greater than 90%

10

A flow rate of (2 L/min)/ (10 L/min) is used for free-flow oxygen administration

10 L/min

For positive-pressure ventilation, adjust the flowmeter to (5 L/min)/(10 L/min)

10 L/min

If an emergency volume expander is indicated, the initial dose is (1 ml/kg)/(10 ml/kg)

10 mL/kg

Oxygen saturation should be 85-95% by (2 min of age)/ (10 min of age)

10 min of age

What oxygen concentration is used when chest compressions are required?

100% O2

The recommended concentration of epinephrine for newborns is (1:1,000)/(1:10,000)

1:10,000

If positive-pressure ventilation is given, at least (1)/(2) qualified providers will be needed at the radiant warmer to perform the necessary steps efficiently.

2

For babies weighing less than 1,000 g, the endotracheal tube size should be (2.5 mm)/(3.5 mm)

2.5 mm

For babies weighing less than 1,000 g, the endotracheal tube size should be (2.5 mm)/ (3.5 mm)

2.5 mmm

Begin positive-pressure ventilation with an inspiratory pressure of (20 to 25 cm H2O)/ (40 to 60 cm H2O)

20 to 25 cm H2O

Ventilation of the term newborn begins at (21% oxygen)/(40% oxygen)

21% oxygen

The ratio of chest compressions to ventilation is (3 compressions to 1 ventilation)/ ( 1 compression to 3 ventilations)

3 compressions to 1 ventilation

If the baby's heart rate remains below 60 bpm, you can repeat the dose of epinephrine every (3 to 5 minutes)/(8 to 10 minutes)

3 to 5 minutes

You should try to take no longer than (30)/(60) seconds to complete the endotracheal intubation procedure

30

Clamping the umbilical cord should be delayed for at least ____ to ____ seconds for most vigorous newborns not requiring resuscitation

30-60

Administer positive-pressure ventilation at a rate of (20 to 25 breaths per minute)/(40 to 60 breaths per minute)

40 to 60

If you are using a device that administers positive end-expiratory pressure (PEEP), the recommended initial pressure is (5 cm H2O)/ (10 cm H2O)

5 cm H2O

You count a newborn's heartbeat for 6 seconds and count 6 beats. You report the heart rate as (36 beats per min)/(60 beats per min)

60

Ventilation that moves the chest has been performed through an endotracheal tube for 30 seconds and coordinated with chest compressions and 100% oxygen for an additional 60 seconds. If the baby's heart rate remains below (60 bpm)/(80 bpm), you should give epinephrine while continuing chest compressions and ventilation

60 bpm

You should briefly stop compressions to check the baby's heart rate response after (30 seconds)/(60 seconds) of chest compressions with coordinated ventilations

60 seconds

What is the compression rate? What is the breathing rate when alternating with compressions?

90 compressions per minute; 30 breaths per minute (*This equals 3 compressions and 1 breath every 2 seconds or 120 "events" per minute*)

What does a Category I fetal heart rate indicate?

A NORMAL TRACING and is predictive of normal fetal acid-base status at the time of the observation, and routine follow-up is indicated

What does a Category III fetal heart rate indicate?

An ABNORMAL TRACING and is predictive of abnormal fetal acid-base status at the time of the observation. A Category III tracing requires prompt evaluation and intervention.

What does a Category II fetal heart rate indicate?

An INDETERMINATE TRACING r/t inadequate evidence to classify them as either normal or abnormal. Further evaluation, continued surveillance, and reevaluation are indicated

Who can be the leader of a resuscitation? When might leadership shift?

Any team member who has mastery of the NRP Flow Diagram and effective leadership skills can be the team leader Leadership can SHIFT if the leader is involved in a procedure that diverts her attention, the leader may appoint another qualified person. If the person in the leadership role changes during the resuscitation, a clear verbal statement should be made so that all team members know who is leading the team.

The correct depth of chest compressions is approximately: A) One-fourth of the AP diameter of chest B) One-third of the AP diameter of chest C) One-half of the AP diameter of chest D) 2 inches

B) One-third of the AP diameter of chest

All newborns require a rapid initial evaluation. Ask if the baby is term, has good tone, and is breathing or crying. If the answer is "NO" to any of these, what should you do?

Bring the newborn to the radiant warmer for the initial steps of newborn care

You have provided warmth, positioned the head and neck, cleared the airway, dried, and stimulated a newborn. It is now 60 sec after birth and she is still apneic and limp. Your next action is to: A. Continue stimulation by vigorously rubbing her back and extremities. B. Give free-flow supplemental oxygen C. Start positive pressure ventilation

C. Start positive pressure ventilation

If the baby IS breathing, the heart rate is ABOVE 100 bpm, the airway is clear and correctly positioned, but the respirations are labored, you may consider (deep pharyngeal suction)/ (CPAP)

CPAP

A newborn is apneic. She does not improve with initial steps and PPV is started. The first assessment of heart rate is 40 bpm. After 30 seconds of PPV that moves the chest, her heart rate is 80 bpm. Chest compressions (should)/(should not) be started. PPV (should)/ (should not) continue

Chest compressions SHOULD NOT be started. (only with a HR below 60) PPV SHOULD continue

A newborn is apneic. She does not improve with the initial steps or PPV. Her heart rate remains 40 bpm. An endotracheal tube is placed properly, the chest is moving, bilateral breath sounds are present, and ventilation has continued for another 30 seconds. Her heart rate is still 40 bpm. Chest compressions (should)/(should not) be started. PPV (should)/ (should not) continue.

Chest compressions SHOULD be started. PPV SHOULD continue.

(true)/(false): All babies who will require neonatal resuscitation can be identified by the presence of perinatal risk factors.

False (Many, but not all)

Where on an infant should you apply chest compressions?

Just below the nipples

The mnemonic "MR. SOPA" can be used to remember the 6 ventilation corrective steps. What are each of the steps?

M= Mask Adjustment R= Reposition the baby's head S= Suction the mouth and nose O= Open the baby's mouth P= Pressure Increase A= Alternative airway

The preferred laryngoscope blade size for use in a term newborn is (No. 1)/ (No. 2)

No. 1

(True) or (False): Some newborns without any apparent risk factors will require resuscitation, including assisted ventilation

True

What is the single most IMPORTANT step in newborn resuscitation?

Ventilation of the newborn's lungs

A baby has received chest compressions and coordinated ventilation. You briefly stop compressions and the electronic cardiac (ECG) monitor shows the baby's heart rate is 80 beats per minute. You should (continue/stop) chest compressions. You should (continue)/(stop) positive pressure ventilation.

You should STOP chest compressions. You should CONTINUE PPV

If a high-risk birth is anticipated, (1 qualified person)/ (a qualified team) should be present at the birth

a qualified team

What is the most important indicator of successful PPV?

a rising heart rate

During the pre-resuscitation team briefing, (prepare for a routine delivery because you do not know what will be needed)/ (anticipate potential complications and discuss how responsibilities will be delegated)

anticipate potential complications and discuss how responsibilities will be delegated

In a full term baby, insert an emergency umbilical venous catheter (at least 8 to 10 cm or until it reaches the liver)/ (approximately 2 to 4 cm or until blood can be aspirated)

approximately 2 to 4 cm or until blood can be aspirated

Epinephrine should be administered (slowly)/ (as quickly as possible)

as quickly as possible

A baby is born limp and apneic. You place her under a radiant warmer, position her airway, remove secretions, and dry and stimulate her. She does not improve. The next step is to (stimulate her more)/ (begin positive-pressure ventilation)

begin positive pressure ventilation

After the initial steps are completed, further decisions are based on assessment of ____________ and ______________

breathing and heart rate

A qualified nurse or respiratory care practitioner who has been trained in neonatal resuscitation and has strong leadership skills (can)/(cannot) be the team leader

can

Every newborn (does)/ (does not) need an initial rapid evaluation of gestational age, muscle tone, and respiratory effort.

does

The vocal cord guide on an endotracheal tube (does)/ (does not) reliably predict the correct insertion depth

does not

If the heart rate cannot be determined by listening with a stethoscope and the baby is not vigorous, use a _____________ ____________

electronic monitor (such as a pulse oximeter)

You have inserted an endotracheal tube and are giving PPV through it. The Co2 detector does not change color and the baby's heart rate is decreasing. The tube is most likely placed in the (esophagus)/(trachea).

esophagus

Before birth, the alveoli in the fetal lungs are (collapsed)/(expanded) and filled with (fluid)/(air)

expanded; fluid

(few)/(many) newborns will require chest compressions or medications

few

Begin positive-pressure ventilation (PPV) if the baby has not responded to the initial steps within the ________ ________ after birth. *Continued use of tactile stimulation in an apneic newborn wastes vulnerable time*

first minute

You have administered PPC for an apneic newborn. The baby's heart rate increased rapidly after the first few breaths. The heart rate is now 120 bpm, the O2 sat is 90% and the baby is beginning to breathe spontaneously. You should (gradually discontinue PPV)/(discontinue pulse oximetry).

gradually decrease PPV

When giving free-flow oxygen with a T piece resuscitator or flow-inflating bag, you should (hold the mask above the baby's face, allowing some gas to escape around the edges of the mask)/ (create a seal by holding the mask tightly to the baby's face)

hold the mask above the baby's face, allowing some gas to escape around the edges of the mask

What is the correct way to give free-flow oxygen?

hold the mask close to the face, but not so tight that pressure builds up within the mask

Epinephrine (increases)/(decreases) coronary artery blood flow and (increases)/(decreases) the strength and rate of cardiac contractions

increases; increases

Your team is resuscitating a baby born at term. His heart rate is 40 bpm after ventilation through an endotracheal tube and coordinated chest compressions. You determine that epinephrine is indicated. Your team should (quickly attempt to place a peripheral intravenous catheter in his right hand)/(insert an umbilical venous catheter or an intraosseous needle)

insert an umbilical venous catheter or an intraosseous needle

The preferred route for epinephrine is (intravenous)/(endotracheal)

intravenous

A baby is born at term with a bilateral cleft lip and palate and a very small mandible. She requires PPV. You are unable to achieve a seal with bag and mask. You have tried to intube twice but have not been successful. Insertion of a laryngeal mask (is)/(is not) indicated)

is

In the absence of shock or a history of acute blood loss, routine administration of a volume expander (is)/(is not) recommended

is not

Both right and left handed people should hold the laryngoscope in their (right)/(left) hand

left

To approximate the heart rate, ......

listen with a stethoscope, count the number of beats in 6 seconds, and multiply the number of beats by 10 (add a zero to the beats counted)

When using suction to clear secretions, first suction the newborn's (mouth)/(nose)

mouth

If using a stylet, the tip of the stylet (must)/(must not) extend beyond the endotracheal tube's side and end holes

must not

A vigorous term newborn may have the initial steps of newborn care performed where?

on the mother's chest or in her arms

Prolonged lack of adequate ____________ and ____________ can lead to organ damage

perfusion; oxygenation

Before birth, oxygen is supplied to the fetus by the (placenta)/(fetal lungs)

placenta

An anatomically shaped mask should be positioned with the (pointed)/(rounded) end of the newborn's nose.

pointed

AVOID vigorous and deep suctioning of the __________ ___________

posterior pharynx

You have started the PPV for an apneic newborn. The heart rate has remained at 40 bpm despite performing all of the ventilation corrective steps and ventilating through an endotracheal tube for 30 seconds. Your assistance sees chest movement with PPV. You should (increase the ventilation rate to 100 breaths/min)/ (processed to chest compressions)

proceed to chest compressions

The oxygen concentration used during resuscitation is guided by the use of a (manometer)/(pulse oximeter) that measures the baby's oxygen saturation

pulse oximeter

Use __________ ___________ and the target __________ ___________ table to guide O2 therapy when resuscitation is anticipated, to confirm your perception of persistent central cyanosis, if you give supplemental oxygen, or if PPV is required. *Visual assessment of cyanosis is NOT reliable*

pulse oximetry; oxygen saturation

After birth, air in the alveoli causes vessels in the baby's lungs to (constrict)/(relax)

relax

Unlike adults, who experience cardiac arrest due to trauma or heart disease, newborn resuscitation is usually the result of ________________ _______________, either before or after birth

respiratory failure

Members of an effective resuscitation team (share information)/(work quietly and independently)

share information

A newborn has been receiving face-mask ventilation, but is not improving. Despite performing the first 5 ventilation corrective steps, the heart rate is not rising and there is poor chest movement. An alternative airway, such as an endotracheal tube or a laryngeal mask, (should)/(should not) be inserted immediately

should

A newborn has been receiving face-mask ventilation, but is not improving. Despite performing the first 5 ventilation corrective steps, the heart rate is not rising and there is poor chest movement. An alternative airway, such as an endotracheal tube or laryngeal mask (should)/(should not) be inserted immediately

should

When a high-risk newborn is anticipated because of the presence of risk factors, resuscitation supplies and equipment (should)/(should not) be unpacked and ready for use

should

You have the glottis in view, but the vocal cords are closed. You (should)/(should not) what until they are open to insert the tube

should

You have started PPV for an apneic newborn. The heart rate is 40 bpm and is not improving with PPV. Your assistant does not see chest movement. You should (start the ventilation corrective steps)/ (proceed to chest compressions)

start the ventilation corrective steps

If you have not completed endotracheal intubation within the recommended time limit, you should (continue the intubation attempt for another 30 seconds using free-flow oxygen to support the baby)/ (stop, resume positive-pressure ventilation with a mask, then try again or insert a laryngeal mask)

stop, resume positive-pressure ventilation with a mask, then try again or insert a laryngeal mask

What is Continuous Positive Airway Pressure (CPAP)?

the gas pressure maintained in the lungs between breaths when a baby is *breathing spontaneously*

What is Positive end-expiratory pressure (PEEP)?

the gas pressure maintained in the lungs between breaths when a baby is receiving *assisted breaths*

What is Peak Inspiratory Pressure (PIP)?

the highest pressure administered with each breath

To insert an orogastric tube, measure the distance from the bridge of the nose to the earlobe and from the earlobe (to the nipples)/(to a point halfway between the xiphoid process and the umbilicus)

to a point halfway between the xiphoid process and the umbilicus

(true)/(false): There is insufficient evidence to make a definitive recommendation on the timing of umbilical cord clamping for non-vigorous newborns

true

Every delivery should be attended by at least 1 skilled person (whose only responsibility is the management of the newborn)/ (who shares responsibility for the mother and newborn's care)

whose responsibility is the management of the newborn

You inserted an endotracheal tube and the CO2 detector changed color when you give positive-pressure breaths. You hear breath sounds with your stethoscope only on the right side of the chest. You should (withdraw)/(advance) the tube slightly and listen with the stethoscope again

withdraw