NRP megacode – Flashcards
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obtains relevant perinatal history
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gestational age fluid expected number of babies additional risk factors
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performs equipment check
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warm clear airway auscultate oxygenate ventilate intubate medicate thermoregulate
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discusses plan and assigns team members roles
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use NRP key behavioral skills throughout resuscitation to improve teamwork and communication
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completes initial assessment
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term tone crying or breathing
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meconium management
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if not vigorous, assist with performs tracheal suction
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performs initial steps
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warm, clear airway if necessary, dry, remove wet linen, stimulate
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evaluates respiration and heart rate
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auscultate apical pulse or palpate umbilicus ( Heart rate less than 60 beats per minute, apneic or gasping.)
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initiates positive-positive-pressure ventilation (ppv) with 21% oxygen
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apply mask correctly, rate 40-60/minute
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calls for aditional help, if needed
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a minimum of 2 resuscitators necessary if PPV required
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requests pulse oximetry
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place probe on right hand before plugging into monitor
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assesses for rising heart rate and oxygen saturation with first 5-10 breaths
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HR remains below 60 bpm* heart rate not rising, pulse oximetry might not be functioning
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assesses chest movement and bilateral breath sounds
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initially respond that bilateral breath sounds are absent and chest is not moving with PPV *
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takes ventilation corrective steps (MR SOPA)
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instructor decides how many corrective steps are necessary: Mask adjustment and Preposition head. Suction mouth and nose and Open mouth increase Pressure ( do not exceed 40 cm H20) use Alternative airway ( ET tube or LMA)
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request assessment of bilateral breath sounds and chest movement performs 30 seconds of effective PPV
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bilateral breath sounds and chest movement are present
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evaluates HR, breathing, and oxygen saturation
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Heart rate remains below 60 bpm* Apneic pulse oximetry might not be funcitoning
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intubates or directs intubation and assesses ET placement
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intubation is recommended prior to beginning chest compressions
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increases oxygen to 100% in preparation of chest compressions
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increase oxygen concentration to 100% when chest compression's begin**
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initiates chest compressions coordinated with PPV
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2 thumbs (preferred) on lower third of sternum, 3 compressions: 1 ventilation compress one-third of the anterior-posterior diameter of the chest
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calls for additional help
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Complex scenario may require more help
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After at least 45-60 seconds of chest compressions, evalute HR, breathing, and oxygen saturation scenario may require more help
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HR remains below 60 bpm Apneic pulse oximetry might not be functioning
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may consider intratracheal epinephrine while umbilical venous catheter ( UVC) is being placed
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CC may be performed from head of infant after intubation. insert UVC 2-4 cm. hold or tape catheter to avoid dislodgement
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after at least 45-60 seconds of chest compression's evaluates HR, breathing, and oxygen saturatoin
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Heart rate remains below 60 bpm Apneic pulse oximeter might not be functoining
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administer or directs administration of IV epi
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Epinephrine 0.1 to 0.3 ml/kg flush UVC with 0.5 - 1 ml normal saline
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after at least 45-60 seconds of CC, evaluate HR, breathing, and oxygen saturtoain
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HR above 60 bpm Occasional gasp Pulse oximetry functioning
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discontinues compression's, continues ventilation at 40-60 breaths/minute
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discontinue compressoins if HR above 60 bpm. reassess every 30 seconds
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Based on scenario, identifies need for volume replacement
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Risk factors: placenta previa, abruption, blood loss from umbilical cord Solutions: normal saline, Ringers lactate or O Rh-negative packed cells Dose: 10 ml/kg over 5-10 minutes Route: Umbilical vein Rate: over 5-10 minutes
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Continue to monitor HR, breathing and oxygen saturation every 30 seconds during resuscitation
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adjust oxygen based on oximetry and newborns age. Continue PPV until HR above 100 bpm with adequate respiratory effort ( newborn may remain intubated)
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Directs post-resuscitation care
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ongoing evaluation and monitoring Communicate effectively with parent(s)
