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You are resuscitating a critically ill newborn whose heart rate is 20 bpm. The baby has been intubated and the endotracheal tube insertion depth is correct. You can see chest movement with PPV and hear bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow. What is the likely reason for this?

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You are resuscitating a critically ill newborn whose heart rate is 20 bpm. The baby has been intubated and the endotracheal tube insertion depth is correct. You can see chest movement with PPV and hear bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow. What is the likely reason for this?

Answer

The answer is inadequate pulmonary blood flow and low cardiac output.

If you are resuscitating a critically ill newborn whose heart rate is 20 beats per minute (bpm) and the baby has been intubated with correct endotracheal tube insertion depth, visible chest movement with positive pressure ventilation (PPV), and bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow, it is likely that there is inadequate pulmonary blood flow.

Colorimetric CO2 detectors change color in the presence of exhaled carbon dioxide (CO2). In a critical situation where a newborn’s heart rate is very low (such as 20 bpm), it is possible that the heart is not effectively circulating blood to the lungs, which means that there is not enough blood to pick up oxygen and release carbon dioxide in the lungs. As a result, there is a lack of exhaled carbon dioxide to change the color of the CO2 detector.

In such cases, it is essential to quickly address the critically low heart rate, which could involve the initiation of chest compressions and administration of medications like epinephrine, as per the neonatal resuscitation guidelines. It is also crucial to have effective ventilation during resuscitation to help improve the heart rate and subsequently improve pulmonary blood flow.

Low cardiac output can lead to inadequate pulmonary blood flow. Since the carbon dioxide (CO2) detector relies on the presence of exhaled CO2 to change color, low cardiac output can result in insufficient blood flow through the lungs, and therefore insufficient CO2 being exhaled. This would cause the colorimetric CO2 detector to not change color.

Following the neonatal resuscitation protocol to improve cardiac output is essential in such a critical situation. This can include measures like chest compressions and the administration of medications like epinephrine.

Please note that in any critical situation involving resuscitation, it is important to follow established protocols and guidelines, and to seek assistance from experienced healthcare providers.

This question is a part of the NRP 8th Edition Test Answers.

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