Case studies in Neonatal CPR via AHI 2005 Guidelines
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Transcript of Case studies in Neonatal CPR via AHI 2005 Guidelines
Case studies in Neonatal CPR
via AHI 2005 Guidelines
By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCPKingwood 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• He is born with APGAR's of 3 .• Is he a candidate for CPR?
answer
• No, he is too small to be considered viable
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?
answer
• Yes, she is premature• Her breathing is irregular • & she has poor muscle tone
Question
• What else do you need to know about this infant?
answer
• Is the amniotic fluid cloudy or clear?
• Is the HR above 100 bpm?• Is the baby centrally cyanotic?
Question
• The baby’s HR is 120 bpm and her lips are cyanotic.
• What do you do now?
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 .
question
You are blowing 02 to her face at 5 lpm.
Her HR is 125 bpmHer RR is 75 bpm with retractionsHer lips are pink after a minute on
02 blow-by
• What do you want to do now?
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
Your patient is a 27-week gestation, infant who is about 1500 grams
What else do you need to know about this infant?
answer
• Is the baby crying?• Does the baby have good muscle
tone?• Is the amniotic fluid clear?
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?
answer
Dry her off, establish an airway and mask bag at 40-60 bpm
Reassess in 30 seconds
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?
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
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?
answer
• 1:3
question
• After 30 seconds of chest compression, and bagging, you recommend what?
answer
• Reassess HR and RR, Sp02 and skin color
question
• How far do we compress the chest during CPR?
Answer:
• 1/3 to ½ the depth of the chest wall
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?
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• 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?
answer
• He is cold-stressed, which has increased his 02 consumption and lowered his glucose levels.
question
• What do you want to do?
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