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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

Review NRP part II

Lone Star college systems: Kingwood

Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP


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…

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

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?

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

  • Poor seal: monitor head position and mask position

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 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%

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

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

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

Reassess pulse in 30 seconds

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

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

.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