Review nrp part ii
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Review NRP part II. Lone Star college systems: Kingwood Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP. Exactly how do we mask bag a newborn?. We select a mask that fits over the nose and mouth without fitting over the eyes We make sure the airway is clear

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Review NRP part II

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Review NRP part II

Lone Star college systems: Kingwood

Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

  • Exactly how do we mask bag a newborn?

  • We select a mask that fits over the nose and mouth without fitting over the eyes

  • We make sure the airway is clear

  • We position the baby’s head in the sniffing position

  • Use less than 30cmH20 pressure to inflate

  • Deliver 40-60 BPM breath…2…3…breath…2…3…


  • How do you know your bagging is effective?

  • With in 30 seconds

    • see & feel the chest rise

    • Have someone listen to the BBS

    • Monitor the patient’s HR which should rise as the baby gets good ventilation

    • Observe the skin color get pinker

    • And the baby’s muscle tone improve


  • What if these good results fail to happen within 30 seconds?

  • Reassess the seal around mask

  • Re-establish head position

  • Increase PIP till you see chest rising

  • If these don’t work, orally intubate

  • Check 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?


  • If you will have to mask bag for more than a few minutes what hazards need to be avoided?

  • Gastric insufflations: get an 8 French feeding tube tube into the baby

  • Poor seal: monitor head position and mask position


  • How long should the feeding tube be?

  • 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 point

  • Insert tube through the mouth & aspirate stomach contents with syringe

  • Remove syringe so gas can be vented from belly


  • When do we start compressions on the newborn

  • 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?

  • 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%


  • What is the Fi02 of the self-inflating manual resuscitator without the reservoir?

  • It is only 40%


  • How do you prepare the T-piece resuscitator?

  • Go here to view picture


  • Set 5-15 LPM from blender or 02 flowmeter

  • Set max pressure at 40 cmH20 [on dial on the left of page. Keep finger over PEEP cap

  • Set PIP on right-sided dial; keep finger over PEEP cap

  • Set the PEEP by removing finger from PEEP cap and adjusting level between zero to 5 cmH20 on the top of the cap itself


  • How do you perform chest compressions in the newborn

  • 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


  • While doing compressions on the newborn do you spend more time going down or coming up?

  • The duration of the downward stroke needs to be slightly shorter than the upward stroke


  • What is the rhythm of chest compressions?

  • One- and- two- and- three- and bag

  • There should be 90 compressions/minute with 30 breaths

  • Do this for 30 seconds before reassessing HR with palpation of umbilical cord


  • What do you do if the compressions are not having an effect

  • Reassess pulse in 30 seconds

  • If there is no pulse rate above 60 , give epinephrine


  • What is the route and the dose of epinephrine in the newborn without a pulse

  • Give via Umbilical Venous Catheter

  • Give 1:10,000 by IV

  • Give .1 mL /kg to .3 mL/kg

  • If instillation down ET tube

  • Raise dose to .3 mL/kg to 1 ml/kg


  • Your baby is 1500 gram. How much epinephrine should she get by IV?

  • .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

  • Continue CPR

  • Continue bagging; reassess BBS and chest rising

  • If 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?

  • Assess the infant for possible pneumothorax

  • Needle aspiration of the chest wall over the area of no BS


The end

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