Practice Question

[rhan101277]

I just wanted to post this up, make sure I am right.

You assess a newborn with cyanosis to the chest and the face and a heart rate of 90bpm. What should you do next?

a. Re-suction the mouth
b. Briskly dry off the infant
c. Begin chest compressions
d. Begin artificial ventilation

I choose D

I don't think you do chest compressions on infants unless the heart rate is 60bpm or lower. Although briskly drying of the infant may help the infant come around and start breathing, I would rather start ventilating him and getting oxygen into him. Re-suction the mouth, I dis-regarded because when they are born you suctioned the nose and then the mouth. Suctioning the mouth probably won't help since infants are nose breathers. Any tips or wrong thinking here?

 

[Norcaldude360]

Actually you would want to suction the mouth first then the lungs in the fact that when you suction the nose, the baby could gasp and possibly start breathing, then aspriate any of the fluid or mecous in the mouth into the lungs.

 

[KEVD18]

Actually you would want to suction the mouth first then the lungs in the fact that when you suction the nose, the baby could gasp and possibly start breathing, then aspriate any of the fluid or mecous in the mouth into the lungs.

we're well past that at this point. we're not talking about the baby just popped out. they are out, cord cut, suctioned etc and the baby isnt pinking up like they should be.

i would agree with d, but ob was never my strong suit. you're reasoning as to why makes sense to me.

 

[rhan101277]

This isn't my strong suit either. Especially since in my discussion i put suction nose then mouth, it is supposed to be mouth then nose.

 

[Epi-do]

I would go with A. It is possible that the mouth wasn't fully suctioned at delivery. If re-suctioning it doesn't immediately begin to make a difference, then begin to bag the baby. In fact, on the delivery I had earlier this year, I had to resuction the little girl. Her breathing immediately improved and she pinked right up. I never had to bag her.

The way I look at it, if there is still something to suction out of the airway and you go ahead and bag, then you run the risk of possibly forcing that fluid into the lungs and causing the aspiration. It only takes a quick second to suction again. You can have the bag right there next to you to immediately start with it if you need to do so.

Did you get this question from a study guide? If so, what does it say the correct answer is?

 

[medicdan]

This isn't my strong suit either. Especially since in my discussion i put suction nose then mouth, it is supposed to be mouth then nose.

I think that's because infants and babies at first are primarily mouth breathers, you want to clear their "larger" airway first.

This question may just have been testing the ABCs...

The choices are:

a. Re-suction the mouth (Airway)
b. Briskly dry off the infant (Exposure, way down the list)
c. Begin chest compressions (Circulation)
d. Begin artificial ventilation (Breathing)

They want the student to identify that Airway is the first priority.

 

[VentMedic]

we're well past that at this point. we're not talking about the baby just popped out. they are out, cord cut, suctioned etc and the baby isnt pinking up like they should be.

i would agree with d, but ob was never my strong suit. you're reasoning as to why makes sense to me.

It this is the situation then,

Central Cyanosis with a HR < then 100

is the pathway you follow for your next step.

Check your algorithm.

 

[MSDeltaFlt]

I just wanted to post this up, make sure I am right.

You assess a newborn with cyanosis to the chest and the face and a heart rate of 90bpm. What should you do next?

a. Re-suction the mouth
b. Briskly dry the infant
c. Begin chest compressions
d. Begin artificial ventilation

I choose D

I don't think you do chest compressions on infants unless the heart rate is 60bpm or lower. Although briskly drying of the infant may help the infant come around and start breathing, I would rather start ventilating him and getting oxygen into him. Re-suction the mouth, I dis-regarded because when they are born you suctioned the nose and then the mouth. Suctioning the mouth probably won't help since infants are nose breathers. Any tips or wrong thinking here?

Since you've already suctioned the mouth, that baby needs stimulation and to be dried. Neonates are very susceptible to hypothermia, and they come out a bit wet. The child is also bradycardic and blue. So, your plan of action for this child is to

Position: clear airway (as necessary)
Provide warmth
Dry, stimulate, reposition
Evaluate: if apneic, gasping or <100 HR, provide PPV
If < 60, provide chest compressions