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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?
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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