Medical Scenario #6

Important Reminder: 

These are hypothetical situations and are not meant to be taken literally. Always follow your hospital's policies, procedures, and guidelines. Your hospital will have specific guidelines that you must follow in each department. These scenarios are purely educational. Always consult with your hospital providers before doing any medical procedure on patients. 

SCENARIO: 

You are a respiratory therapist working in the Neonatal Intensive Care Unit (NICU) when you receive an urgent call from the delivery room. A full-term infant has just been delivered via spontaneous vaginal delivery. The mother had an uneventful pregnancy, and there were no complications during labor. However, upon delivery, the baby appears grunting, with mild retractions, and has a respiratory rate of 80 breaths per minute. The heart rate is 140 bpm, and oxygen saturation (SpO2) is 92%. You arrive to the baby at the radiant warmer at 2 minutes of life. 

Vital Signs: 

• Heart Rate (HR): 140 bpm 

• Respiratory Rate (RR): 80 breaths per minute 

• SpO2: 67% 

• Temperature: Not assessed yet 

• Blood Pressure: Not assessed yet 

STOP & DISCUSS:  

What interventions are necessary at this time? 

ANSWER:  

Since HR is greater than 100 bpm PPV is not necessary. The patient is showing signs of increased work of breathing.  CPAP is indicated. Typically, CPAP of 5 cm H20 is a good starting point.  SPO2 is within normal limits at 2 minutes of life so Fio2 should be set at 21%. You may want to check the baby to see if suctioning is necessary since there is increased work of breathing. Routine suctioning should be avoided.

ACTION:  

CPAP is started at 5 cm H20. Fio2 is started at 21%. 

SITUATION:  

You notice the grunting and retracting has subsided after 1 minute of CPAP. 

You discontinue CPAP and continue to monitor the baby until your 5-minute APGAR, which ends up being an APGAR score of 9.

The doctor asks you to assign the 1 and 5 minute APGAR scores. 

STOP & DISCUSS:  

What is the APGAR Score for the baby at 1 minute of life? 

ANSWER:

Since you were not present at 1-minute of life, you cannot give the 1 minute APGAR scores. The team member who was present at 1-minute of life will have to make that decision. 

Always discuss APGAR scores with the other associates who are involved in the resuscitation. APGAR scores can sometimes be subjective, so it is imperative that you all agree on the final scores. 

SITUATION: 

 The baby ended up being completely fine and stayed with the mother in the maternity ward. What should you do once you get back to the unit? 

ANSWER:  

You should enter complete documentation of everything you performed in the patient's chart.  This includes details such as cord clamping, suctioning, sputum color, sputum consistency, warm/dry/stimulate, color, pulse, SpO2, APGARS, CPAP pressure, Fio2, and reaction to all interventions.

Important Reminder: 

These are hypothetical situations and are not meant to be taken literally. Always follow your hospital's policies, procedures, and guidelines. Your hospital will have specific guidelines that you must follow in each department. These scenarios are purely educational. Always consult with your hospital providers before doing any medical procedure on patients.