Module 7 OBGYN Practical Newborn CPR Question

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Just finished Module 7, which was OBGYN, Pediatrics, Special Needs, and Geriatrics.

I got a 94/100 on the written exam.

For my practical I had the following scenario:
The pt. was a dummy/ Instructor, I had an imaginary parter.

Older woman in her 40s who had her tubes tied. I completed my scene size up and patient assessment. Upon palpating the pt. I was instructed that I felt contractions. The contractions were 5 minutes apart and had been going on for the last 5 hours. The scene was the lady's house. I moved the pt to the cot, while I timed the contractions as my partner took vitals. The baby began crowning. I tore the amniotic sack with my finger.The umbilical cord was completely wrapped around its neck, a scenario not gone over in our EMT book or protocols. The baby was stuck, so I had my partner suction, while I clamped the visible cord and cut, and delivered the baby. I ran through APGAR while beginning the universal algorithm.

I had partner take vitals of baby, while I dried, warmed positioned, and suctioned the baby.

Baby was cyanotic with HR of 45. I began ventilations by BVM w/ 15lpm O2 for 30 seconds. After 30 seconds HR was still at 45, so I began compression 3:1.

Now according to my instructor I failed because he asked me the following:

How long do you wait to recheck the pulse. I said I continue doing compressions until baby resuscitates. He asked the question again, and I thought back to AHA CPR of 2 minutes of CPR then switch with partner and we would check vitals or have AED on while we switched.

So he failed me because I took too long to recheck the HR. I asked him what was the correct time, he said 30 seconds.

30 seconds??? I can't find that in my book or protocols or AHA notes.

He made a comment that I didn't read the book. I sure did! I studied my *** off an got a 94/100 on the written.

So my head instructor read the notes and had no idea where the 30 second rule came from, so he overruled the decision and let me pass.

The thing is, this guy who gave me the practical is a state examiner, so I am really curious where he got the information, since I take the state exam next week.


Anyone heard of the 30 seconds of newborn CPR then recheck HR method?
 
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When was the last time you took NRP? I guess I should ask if you have even taken it first.

NRP stipulates re-assessment every 30 seconds with escalating efforts as appropriate.

Don't like to be that guy but your instructor gave you a freebie. By current NRP standards you failed the scenario.
 
Ah thanks for the information. I took the AHA CPR course for providers. Is the NRP a separate course?



I appreciate your input. You wouldn't happen to know of a god source with this information online?
 
Initial neonatal resuscitation no longer calls for use of high concentration oxygen . Evidence exists for worse outcomes. Room air is to be used initially. Europe has been doing this for years with better outcomes than the US.

And NvRob is correct, re-assess every 30secs and escalate your intervention.
 
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Nor is NRP 3-1 CPR typically taught in medic school. As an AHA instructor and Medic Program instructor i would have a hard time failing him on this point also. But it would have been a great teaching point so this person and the rest of class realize that they will not know everything coming out of a medic program and that seeking further specialized education is needed, IE NRP
 
Best source is taking the class. Search "Neonatal Resuscitation Program" on google to check out classes near you.

What level are you at? B, I or P? At the Basic and even I/A level NRP has potential to just confuses you further.

Edit: NRP was included in my Medic program along with ACLS, PALS, ITLS and ITLS Access and we were held to those standards in testing. We did CBRNE as well but I have my own personal thoughts on the usefulness of that class when it comes to the standard "street" medic.
 
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EMT- Basic

I will look into Neonatal Resuscitation Program courses.
 
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Yeah hopefully at somepoint NRP will be taught at every medic program. I took it on my own as i have a black cloud over me field deliveries
 
EMT Basic. Makes alot more sense now. And like NV said, now you know.
 
Interestingly, as far as BLS resuscitation (per both AHA and most EMT curricula), very little is said about that situation. In other words, you're told to begin CPR if the rate is below 60, but not when to stop.

For testing purposes I would call it a trick question.
 
I don't know if this will help, but here's the rationale: newborns respond very quickly to resuscitation. Lung stretch from bagging is vagolytic, while compressions serve as a stop-gap while they take over for themselves. Sometimes they just need a little help.
 
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