This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'Meconium aspiration is done for 3 times but no breathing occurs. Next step in resuscitation would be – \nSelect and explain. \nA. Chest compression, B. O2 inhalation, C. Bag & mask intubation, D. Trikling of sole', 'role': 'user'}, {'content': "Answer: D \nExplanation: To solve this question, one should know the resuscitation protocol of newborn.\nResuscitation protocol\n\nAs soon as the baby is delivered, five signs are assessed -\n\n\nClearance of meconium\nActive breathing or crying\nGood muscle tone (flexed posture and active movement of baby).\nPink color (look at tougue and lips)\nTerm gestation (delivery between 37-42 weeks of pregnancy).\n\n\nIf all signs are positive no active resuscitation is required.\nIf any of the 5 signs is absent, baby requires resuscitation.\nThe baby should be placed under the heat source (radiant warmer) and subjected to a set of intervention known as initial steps.\n\nInitial steps of resuscitation\n1. Positioning\n\nThe neonate should be placed on her back or side with the neck slightly extended.\nThis can be achieved by putting a rolled blanket or towel under the shoulders, elevating them 3/4 or 1 inch off the mattress.\n\n2. Suctioning\n\nThe mouth and nose should' be suctioned\nThe mouth is suctioned first to ensure that there is nothing for the infant to aspirate when the nose is suctioned.\nOne should not insert the catheter very deep in mouth or nose for suction ---> Stimulation of posterior\n\npharynx during the first few minutes after birth can produce a vagal responce, causing severe bradycardia or apnea.\n3.Dry, stimulate and reposition\na After suctioning, the baby should be dried by using pre-warmed linen to prevent heat loss.\n\nA brief tactile stimulation in the form of flicking the soles or rubbing the back may be provided in case of non-establishment of ood res irator efforts.\n\n4. Free flow of oxygen\n\nIf the baby continues to be depressed, provide free flow of oxygen using a facemask.\nAfter providing initial steps, the baby should be evaluated for three signs -\n\n\nRespiration\nHeart rate (HR)\nColor\n\n\nIf baby has good breathing, HR >100 and pink color, he should be given supportive care.\nIf the baby is not breathing well or HR <100 then bag and mask ventilation is needed.\nAfter the infant has received 30 seconds of ventilation with 100% oxygen by bag and mask, evaluation of heart rate should be done -\n\nHR>100\xa0\xa0\xa0\xa0\xa0\xa0 --->\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Discontinue ventilation if spontaneous respiration is present\nHR 60 to 100 -->\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Continue ventilation\nBelow 60\xa0\xa0\xa0\xa0 -->\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Continue ventilation + chest compressions\n\nAfter 30 seconds of chest compressions, the heart rate is checked.\n\nBR< 60\xa0\xa0\xa0\xa0\xa0\xa0\xa0 -p\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Continue chest compression and bag & mask ventilation + initiate medications.\nBR > 60 Discontinue chest compression but continue bag & mask ventilation until the heart rate is above 100.", 'role': 'assistant'}]