CPAP for EMS Providers and Episode 177
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Welcome to Episode 177
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EMS News-
Tasered Man Catches Fire! (from Listener David)
Incidence of Heat-Related Sickness Rise in Oklahoma
Health Care Reform Much Needed in Rural US
Oklahoma Trooper Sued by Paramedic
Canadian Workforce Affected by Pandemic
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Tip of the Week CPAP for EMS Providers
Continuous Positive Airway Pressure (CPAP)is a non-invasive procedure usually given in the prehospital setting aimed at improving the status of a patient with respiratory problems by reducing work of breathing. In some patients, it is used as an alternative for intubation.
CPAP is usually given in conjunction with emergency medications such as nitrates, diuretics or bronchodilators depending on the respiratory problem the patient is having.
Indications for CPAP are:
- CHF/Acute Pulmonary Edema
- Acute Respiratory Failure
- asthma/reactive airway disease,
- near drowning,
- COPD,
- acute pulmonary edema (cardiogenic and non cardiogenic)
- pneumonia
Administration should start at lowest setting (0-2 cmH20) and titrated upward to 10 cmH2O.
When providing CPAP, the paramedic should verbally calm the patient and provide coaching since it may induce anxiety.
Complications that emergency medicine providers should anticipate include drop in blood pressure, pneumothorax, gastric distention and vomiting, and corneal drying.
Contraindications to CPAP are:
- Unconscious, Unresponsive, or inability to protect airway.
- Inability to sit up
- Respiratory arrest or agonal respirations (Consider Intubation)
- Persistent nausea/vomiting
- Hypotension- Systolic Blood Pressure less than 90 mmHg
- Inability to obtain a good mask seal
- Pathologic
- Suspected Pneumothorax
- Shock associated with cardiac insufficiency
- Penetrating chest trauma
- Facial anomalies /trauma/burns
- Closed Head Injury
- Has active upper GI bleeding or history of recent gastric surgery
- Vomiting
CPAP therapy should be given continuously to obtain maximum benefits. In the event that it should be discontinued, Intermittent Positive Pressure Ventilation or Endotracheal intubation should be considered.
Maryland EMS Provider Protocols
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Matthew Ebel with “Drive”
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Until next time, Scene safety, BSI!
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Comments on CPAP for EMS Providers and Episode 177
CPAP is a wonderful tool for PE and can be life saving. With the advent of lightweight breathing systems and materials we can now easily apply it in the field. These systems are now very portable and should be on the units, obviously extra training will be required to use it, but with our aged community living longer we will start seeing parts of their body giving up……..
Unfortunately here in WA, Australia our Medical Director does not want to use the well established premanufactured devices on the market, no! he wants to design his own………. What with that and the issue of minimal refresher training being provided to maintain skills let alone upgrade to new skills……that is another story!!