Date post: | 17-Dec-2015 |
Category: |
Documents |
Upload: | lenard-hancock |
View: | 215 times |
Download: | 1 times |
Review NRP part IIReview NRP part IILone Star college systems: Kingwood
Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP
answeranswer
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…
answeranswer
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
answeranswer
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?
answeranswer
Gastric insufflations: get an 8 French feeding tube tube into the baby
Poor seal: monitor head position and mask position
answeranswer
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
answeranswer
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?
answeranswer
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%
answeranswer
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
answeranswer
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
answeranswer
The duration of the downward stroke needs to be slightly shorter than the upward stroke
answeranswer
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
answeranswer
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
answeranswer
.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
answeranswer
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?
answeranswer
Assess the infant for possible pneumothorax
Needle aspiration of the chest wall over the area of no BS