Apnea
Apnea is defined as bradycardia OR color change AND this many seconds between respirations.
What is greater than or equal to 20 seconds?
You are doing your safety checks at the bedside and notice a T-piece and a flow-inflating bag. Your patient is 34 weeks PMA. You would use this piece of equipment if resuscitation is needed.
What is the flow-inflating bag?
For patients > 32 weeks gestation, a flow-inflating bag is used. For patients 32 weeks or less use a T-piece.
This is when you start chest compressions.
What is when the infant is unresponsive to respiratory interventions and the HR is < 60 BPMs.
This medication is used to prevent apneic episodes in infants by stimulating the respiratory center and improving diaphragm contractility.
Clue: it makes everyone jealous
What is caffeine?
What is obstructive apnea?
Other causes of obstructive apnea include weak respiratory muscles, impaired coordination of inspiratory muscles and muscles of the upper airway, poor neck tone, passive neck flexion, and nasal obstruction.
Apnea of Prematurity (AOP) usually starts within this timeframe.
What is 2 to 7 days?
AOP usually starts a couple days after birth. It is unusual to start having AOP after day 7 of life.
You need to start PPV with a flow inflating device. You know to start the PIP and PEEP within these parameters.
What is 20-35 for PIP and 5-8 for PEEP?
Start low with the goal to obtain adequate chest rise.
This the cadence for chest compressions in the NICU.
What is 1, and 2, and 3 and breathe?
When using NRP, the appropriate dose of Epinephrine is ____. When the infant qualifies for PALS, the appropriate dose of Epinephrine is _____.
What is:
NRP: IV or IO: 0.02 mg/kg equal to 0.2 mL/kg of 1:10,000
PALS: IV or IO: 0.01 mg/kg equal to 0.1 mL/kg of 1:10,000
My patient is alarming and did not respond to tactile stimulation, so as a result I turned the infant supine, repositioned the head/neck, and suctioned the airway. I performed these types of stimulation.
What is mild and moderate stimulation?
Apnea spells in term infants are always considered (normal or abnormal)?
What is abnormal?
Apnea in term infants is always considered abnormal and are associated with serious, identifiable causes such as birth asphyxia, intracranial hemorrhage, seizures, or depression from medication.
Your patient is on HFNC and did not respond to moderate stimulation during an apneic episode. Your next steps are..
What are the steps for vigorous stimulation?
Remove HFNC because prevents a good seal and too much pressure could cause a pneumo
Apply CPAP
Adjust O2 to 10% above baseline
Begin PPV if infant not breathing.
During apnea, it is theorized that hypoxic stimulation of the carotid chemoreceptors causes this.
What is bradycardia?
Bradycardia is the absence of a QRS complex for > 3 seconds. Typically, a brady event is a HR <100 for <34 weeks or HR <80 for >/= 34 weeks.
You are planning to intubate your patient. You anticipate the provider will order ____ due to it's vagolytic properties to decrease the risk of bradycardia and other cardiovascular instability.
What is atropine?
The RN should complete or designate these steps when preparing for intubation.
What is:
1. Obtain intubation kit, 10 Fr suction catheter, and tape (RT may complete)
2. Lower the head of bed
3. Turn infant perpendicular in bed
4. Place blanket roll under infant’s shoulders for “sniffing position”.
5. Obtain meds
6. Prepare to assist provider as delegated (cricoid pressure, hold suction, restrain patient, monitor VS changes, etc.)
Infection can lead to central apnea due to these signaling proteins.
What are cytokines and interleukins?
The cytokines and interleukins (IL) response to infection causes prostaglandin release, depressing brain stem respiratory activity and leading to apnea.
What is Breathe... 2... 3... Breathe?
Before starting chest compressions, ensure that effective PPV was performed for this length of time.
What is 30 seconds?
Atropine should be administered (rapidly or slowly) to prevent ______.
What is rapid administration to prevent paradoxical bradycardia?
The pedi-cap turns from ____ to ____ if the ETT is in correct position.
What is purple to yellow?
This impairment is thought to be the cause of central apnea in premature infants.
What is chemosensitivity?
Immaturity of the preterm brain is manifested by impaired ventilatory responses to hypoxia and hypercapnia. Hypercapnia does not trigger respiratory drive like it does in term infants. Preterm infants may also have poor breathing patterns in response to hypoxia (transient hyperventilation followed by hypoventilation).
These are the steps you take with MRSOPA.
What is MR SOPA?
M - Mask adjustment R - Reposition head and neck to open airway
Reattempt to ventilate. If not effective... S - Suction the mouth then nose O - Open the mouth and lift jaw forward
Reattempt to ventilate. If not effective... P - Pressure increase (ensure appropriate flow rate. 8-10 LPM) A - Alternative Airway (ETT or LMA)
https://youtu.be/M6fn-Unv8Mo?si=gkPj3hZuT_twbfd_
You stop compressions when the infant's HR is this.
The normal sequence for intubation medications given IV is _____, _______, ______. If unable to get an IV, you would anticipate the provider to order _____ or _____.
What is:
IV: Midazolam, Fentanyl, Vecuronium or Rocuronium
IM: Intranasal Fentanyl or Intranasal Midazolam
You need to give Fentanyl (quickly or slowly) in order to prevent ______. If that happens, you would anticipate these next steps.