RESP 202 - Pediatric and Neonatal Advanced Critical Care

1. Describe fetal development
2. Identifies maternal high risk factors associated with birth process
3. Discuss neonatal effects of medications delivered to the mother during pregnancy (suppression of labor, promotion of fetal lung maturity, maternal drug dependency)
4. Understands the transitional phase from utero to birth process, include how gas exchange occurs in utero and after birth
5. Evaluate data in the patient record
   1. Laboratory results (bilirubin and glucose)
   2. Blood Gas Analysis and/or hemoximetry (CO-oximetry) results (ABG, CBG)
   3. Maternal and perinatal/neonatal history (Apgar, gestational age, L/S ratio)
   4. Trends in
      1. fluid balance
      2. compliance, resistance and work of breathing
      3. non-invasive (pulse oximetry, capnography, transcutaneous)
6. Perform a clinical assessment by inspection to include:
   1. General appearance
   2. Status of a neonate (APGAR, gestational age)
7. Perform a clinical assessment by reviewing a chest radiograph to assess:
   1. Quality of imaging (patient positioning, penetration, lung inflation)
   2. Presence and position of airways, lines and drains
   3. Presence of foreign body
   4. Cardiopulmonary abnormalities (pneumothorax, pleural effusion, consolidation, pulmonary edema, pulmonary artery size)
8. Perform procedures to gather clinical information:
   1. Noninvasive monitoring (pulse oximetry, capnography, transcutaneous)
   2. Blood gas sample collection (ABG, CBG)
   3. Cardiopulmonary calculations (PA-aO2, Vd/Vt, P/F, OI)
   4. Apnea monitoring
9. Evaluates procedures results:
   1. Noninvasive monitoring (pulse oximetry, capnography, transcutaneous)
   2. Blood gas analysis and/or hemoximetry (co-oximetry) (ABG, CBG)
   3. Cardiopulmonary calculations (PA-aO2, Vd/Vt, P/F, OI)
   4. Apnea monitoring
10. Recommend diagnostic procedures:
    1. Imaging studies
    2. Noninvasive monitoring (pulse oximetry, capnography, transcutaneous, transillumination)
    3. Hemodynamic monitoring (UAL)
11. Assemble and troubleshoot equipment:
    1. Medical gas delivery devices and interfaces (mask, cannula, heated high-flow cannula, flow meters, blender, gas analyzer (O2, NO)
    2. CPAP/NPPV with patient interfaces
    3. Resuscitation devices (self-inflating resuscitator, flow-inflating resuscitator, Neo-tee)
    4. Mechanical ventilators
    5. Patient breathing circuits
    6. Heliox delivery device
    7. Noninvasive monitoring devices (pulse oximeter, capnometer, transcutaneous)
    8. Hemodynamic catheters (UAL)
12. Perform quality control procedures on noninvasive monitors (including TCM)
13. Support oxygenation and ventilation by initiating and modification of
    1. Initiating and adjusting mechanical ventilation
       1. Continuous mechanical ventilation
       2. Noninvasive ventilation
       3. High-frequency ventilation
       4. Ventilator alarms
       5. ECMO
       6. PEEP
    2. Recognizing and correcting patient-ventilator dyssynchrony
    3. Utilizing ventilator graphics
    4. Liberating patient from mechanical ventilation
14. Administer specialty gases (heliox, inhaled NO, Nitrogen)
15. Ensure modifications are made to the respiratory care plan
    1. Treatment termination (life threatening adverse event)
    2. Starting treatment based on patient response
    3. Treatment of pneumothorax
    4. Adjustment of fluid balance
    5. Liberating from mechanical ventilation
    6. Discontinuing treatment based on patient response
    7. Make recommendations for changes to mechanical ventilation
    8. Make recommendations for pharmacological interventions (inhaled pulmonary vasodilators)
16. Utilize evidence-based or clinical practice guidelines in:
    1. Classification of disease severity
    2. Recommendations for changes in a therapeutic care plan when indicated
    3. Application of guidelines to include: NAEPP, NRP/PALS, STABLE
17. Provides respiratory care in a high risk situation cardiopulmonary emergencies, excluding CPR
18. Assist a physician/provider in performing procedures
    1. Withdrawal of life support
19. Demonstrates Knowledge Concepts of Mechanical Ventilation:
    1. Review basic modes of ventilation from RESP 104 (CMV-PC, IMV-PC, Spontaneous)
    2. Describe selected advanced techniques of mechanical ventilation of the neonatal, pediatric patients. (e.g. NAVA, PAV, APRV, PRVC)
20. Use objectives #5-19 to discuss each of the following pathologies:
    1. Pediatric(Croup, Epiglottitis, RSV/Bronchiolitis, Foreign Body obstruction, Kyphoscoliosis, Poisoning/toxic ingestion)
    2. Neonatal (Delivery room care, Apnea of prematurity, Meconium aspiration, Congenital Diaphragmatic Hernia, Cardiac Anomalies, Persistent Pulmonary Hypertension, Bronchopulmonary Dysplasia, Transient Tachypnea Newborn, Pulmonary Interstitial Emphysema
    3. Diffuse Alveolar Disease (IRDS)

 

COURSE CONTENT: Topical areas of study include -  

• Fetal development
• Assessment and basic care of the neonatal and pediatric patients
• Selected neonatal and pediatric disease listed in Objective #20
• Mechanical ventilation concepts, effects
• Ventilator Graphics
• Modes for ventilation for neonate, pediatric
• PALS / NRP
• S.T.A.B.L.E
• Evaluations

Procedures:

• Newborn Assessment/Resuscitation (Basic Airway Care - Bulb Suctioning)
• Pediatric Assessment
• Oxyhood setup
• CPAP
• Pediatric and Neonatal Mechanical Ventilation Initiation
• Pediatric and Neonatal Mechanical Ventilation Rounds
• Pediatric and Neonatal Mechanical Ventilation Circuit change
• Neonatal inline suctioning
  TOTAL PROCEDURES: 8

 
Course Addendum - Syllabus (Click to expand)