Flashcards in Week 2 Neonatal Assessment and Resuscitation (everything) Deck (87)
There are some similarities between the initial assessment of the neonate and the initial assessment of an adult who requires resuscitation. In both situations, the physician should give immediate attention to
ABCs of resuscitation (i.e., airway, breathing, circulation).
what is the normal neonatal respiratory rate
30-60 Breaths per minute
neonatal breathing should begin at ____seconds and be regular by ____ seconds of age
regular at 90
if a neonate does not breath by 90 seconds of age this may indicate ____ or ____ apnea
primary or secondary apnea
what helps initiate breathing efforts during primary apnea
tactile stimulation can initiate breathing efforts
low heart rate is presented which apneas
primary and secondary
reduction of blood pressure is presented during which apneas
if tactile stimulation does not result in the initiated of spontaneous breathing what is the next step
aggressive resuscitation must be initiated promptly if tactile stimulation does not initiate spontaneous breathing
how many weeks gestation is the fetus for meconium to be present in the intentional tract
which type of pregnancy has the higher incidence of meconium stained amniotic fluid
post term pregnancies
meconium stained amniotic fluid is present in
10-15% of all pregnancies
the preterm neonate- especially the VLBW infant is at higher risk for what problems
Multiple organ system problems simply because of immaturity
what is the treatment for meconium aspiration syndrome?
PPV and is associated with a 5-20% incidence of pneumothorax from pulmonary ark leaks.
what is meconium aspiration syndrome
respiratory distress in a neonate whose airway was exposed to meconium and whose chest radiograph exhibits characteristic findings (pulmonary consolidation and atelectasis)
what was the common practice for meconium aspiration syndrome- no longer done, but may still see it in practice
In an attempt to reduce inhalation of meconium from the pharynx and thus prevent or reduce the severity of MAS the practice of suctioning the mouth and pharynx after delivery of the head, and subsequent intubation to remove meconium from the trachea , was common practice. However, studies have documented that airway suctioning at birth does not prevent MAS
Congenital Anomalies can cause special issues related to what
special resuscitation issues.
congenital abnormalities that cause upper airway obstruction include
micrognathia, macroglossia,laryngeal webs, laryngeal atresia, stenosis , subglottic webs, tracheal agenesis, tracheal rings
what is Exit Procedure - ex utero intrapartum treatment procedure
delivers the fetal head and shoulders, but keeps the lower torso and umbilical cord intact within the uterus. allows surgeon to perform direct laryngoscopy, rigid bronch, tracheostomy. allowing establishment of an airways prior to completing delivery.
what is the benefit of the exit procedure
thereby maintaining placental perfusion and oxygenation
Congenital high airway obstruction syndrome (CHAOS)
Intrinsic airway obstruction of the larynx or upper trachea (e.g., laryngeal web, subglottic cyst, tracheal atresia) can lead to retention of bronchial secretions and subsequent pulmonary distention; this constellation of findings is often classified as
long term survival of children with congenital high airway obstruction syndrome long term survival results when """ this procedure is used
talk to me about ethical considerations of non initiating resuscitating in the delivery room
extremes of prematurity < 23 weeks. (although massey said we can save down to 20) severe congenital anomalies (anencephaly, confirmed trisomy 13, 18)
talk to me about ethical considerations when stopping resuscitation is appropriate
once further information has been obtained and discussion with family has occurred.
-remember a trial of therapy may be appropriate
for those situation with a poor prognosis- unlikely survival or high morbidity (23-25 weekS) how to we handle the parents desires to initiation of resuscitation
should be supported
the fetus is connected by the
umbilical cord to the placenta
the fetus gets all needed nutrition and oxygen via
the blood vessels in the umbilical cord
Wast products and CO2 from the fetus are sent back through the umbilical cord and
placenta to the mother's ciruculation to be removed
**the fetal circulatory system uses how many shunts?
**The purpose of these shunts in fetal circulation is to
bypass the lungs and liver