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Case studies in neonatal cpr via ahi 2005 guidelines
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Case studies in Neonatal CPR via AHI 2005 Guidelines. By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP Kingwood College Respiratory Care Department Kingwood College Kingwood, Texas. Question: Case # 1. Your baby is 20 week gestation by dates and by exam. His weight is 350 grams

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Case studies in neonatal cpr via ahi 2005 guidelines

Case studies in Neonatal CPRvia AHI 2005 Guidelines

By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

Kingwood College Respiratory Care Department

Kingwood College

Kingwood, Texas


Question case 1

Question: Case # 1

  • Your baby is 20 week gestation by dates and by exam.

  • His weight is 350 grams

  • He is born with APGAR's of 3 .

  • Is he a candidate for CPR?


Answer

answer

  • No, he is too small to be considered viable


Question case study 2

Question: Case study # 2

  • Your patient is 24 week’s gestation by dates.

  • She is flaccid and breathing is irregular & she doesn’t respond to tactile stimulation while you dry her off.

  • Is CRP indicated?


Answer1

answer

  • Yes, she is premature

  • Her breathing is irregular

  • & she has poor muscle tone


Question

Question

  • What else do you need to know about this infant?


Answer2

answer

  • Is the amniotic fluid cloudy or clear?

  • Is the HR above 100 bpm?

  • Is the baby centrally cyanotic?


Question1

Question

  • The baby’s HR is 120 bpm and her lips are cyanotic.

  • What do you do now?


Answer3

answer

  • Dry her off

  • Bulb suction her if she needs it

  • Place her in the sniff position.

  • Blow 02 and

  • Reassess her for better skin color & regular RR .


Question2

question

You are blowing 02 to her face at 5 lpm.

Her HR is 125 bpm

Her RR is 75 bpm with retractions

Her lips are pink after a minute on 02 blow-by

  • What do you want to do now?


Answer4

answer

  • Place her under a hood

  • Get a pulse-oximeter on her to titrate the Fi02

  • Reassess her because we are concerned about her being flaccid.


Question case study 3

Question: Case study # 3

Your patient is a 27-week gestation, infant who is about 1500 grams

What else do you need to know about this infant?


Answer5

answer

  • Is the baby crying?

  • Does the baby have good muscle tone?

  • Is the amniotic fluid clear?


Question3

Question

  • When you assess this infant for these items you note that the baby’s HR is 55 bpm, the respiratory rate is 15 bpm and the baby is flaccid.

  • What do you do at this point?


Answer6

answer

Dry her off, establish an airway and mask bag at 40-60 bpm

Reassess in 30 seconds


Question4

Question

  • After 30 seconds, the HR is at 54 bpm, the patient is centrally cyanotic even with bagging with Fi02 100% at a rate of 50 bpm.

  • What do you want to do?


Answer7

answer

  • Observe the chest for good chest movement

  • Listen to the BBS for good bagging

  • Intubate now &

  • Start compressions at a HR of 90 bpm


Question5

question

You are bagging at 30 bpm, the chest is rising & The nurse is doing chest compressions at 90 bpm

  • What is the ratio of compressions to RR?


Answer8

answer

  • 1:3


Question6

question

  • After 30 seconds of chest compression, and bagging, you recommend what?


Answer9

answer

  • Reassess HR and RR, Sp02 and skin color


Question7

question

  • How far do we compress the chest during CPR?


Answer10

Answer:

  • 1/3 to ½ the depth of the chest wall


Question8

question

  • The HR is 45 bpm

  • The Sp02 is 76% on Fi02 100%

  • There is a 3.0 endotracheal tube down to # 10 and you hear BBS with bagging.

  • There are no spontaneous breathing efforts & the skin is mottled

  • What do you suggest we do at this time?


Answer11

answer

  • Continue to do compressions and bagging with 02

  • Reassess in 30 seconds

  • If no response, give IV epinephrine

  • Continue compressions, bagging and reassess in 30 seconds

  • Check glucose levels and if low give glucose

  • Give volume expanders if hypotensive

  • Perform CPR for 10 minutes before stopping


Question case study 4

Question: Case study # 4

  • Your patient is a 35 week by gestation by dates. His mom has gestational diabetes. He has a APGAR of 6 at 1 minute & 7 at 5 minutes

  • His RR is 65 bpm with minimal retractions, no flaring

  • His HR is 135 bpm

  • He is placed under a croup tent at 40%

    and his Sp02 rises from 88% to 91%

  • After 10 minutes, you note that his Sp02 has dropped to 85% and that his skin is mottled and he is breathing irregularly

    What has happened?


Answer12

answer

  • He is cold-stressed, which has increased his 02 consumption and lowered his glucose levels.


Question9

question

  • What do you want to do?


Answer13

answer

  • Increase his Fi02

  • Reassess Sp02 and his respiratory rate

  • Mask bag if his RR is still irregular

  • Get his temperature & place him under a heated hood to raise his body temperature

  • Get a serum glucose and replace the glucose he’s used up


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