Category Archives: CPAP

Does cpap have to be used with nitro

Hi Doc(s), Two unrelated questions I've been pondering over the last couple of days: 1. In the field I've noticed some paramedics withhold dimenhydrinate administration if the patient has already taken any Gravol in the last 4-6 hours. However, the medical directive does not specify a time and simply states overdose on antihistamines or anticholinergics or tricyclic antidepressants. My understanding of their logic is that additional Gravol may cause an overdose in the patient however Gravol brand themselves recommend a dose of 1-2 50mg capsules every 4hrs PRN... Could you please provide some further clarification on this practice, and if we should still be administering it if we do not suspect an overdose but that the medication has been taken appropriately. (and similar practice for if the patient is taking tricyclics or anticholinergics as prescribed to them) 2. I recently had a COPD exacerbation patient who I believe would have benefitted greatly from CPAP. He had equal lung sounds through all fields with no paroxysmal chest movement, however there was a recent history of a collapsed lung approx. 6 weeks prior. (Unknown cause, from his history I suspect possibly a bleb/bullae) The current extenuating circumstance of COVID-19 aside, should CPAP be considered in this patient? Although I am not suspecting a current pneumothorax, due to the recent history I would think that weakening of the lung tissues could put the patient at greater risk for a recurrent event if subjected to significant positive pressures. Thank you and stay safe!

Are we entitled to the scientific reasoning why we are no longer providing CPAP to patients? What is the expectation when I am unable to confirm COVID-19 and my immediate presentation would improve with CPAP administration?

Question: Is PEEP being considered for inclusion into the paramedic scope of practice? I recently had a patient who was in CHF to the point of unconsciousness whom we would have absolutely given CPAP had he been conscious. Although PEEP isn't exactly the same as CPAP, would it not have potentially provided some benefit?

Question: In the event we have a patient who is STEMI positive, with symptoms of CHF (crackles/pitting edema) who is hypertensive >140 systolic BP are we to treat with 0.8mg of nitro for the CHF or 0.4 mg under the ischemic chest pain protocol? Also with the new STEMI standard dropping down to 3 - 0.4mg SL doses of nitro maximum, will that change out CHF protocol for nitro administration if both problems present together?

Question: In a patient presenting with respiratory distress, crackles and a relevant cardiac history, I would assume that left ventricular failure/infarct would be a fair working assessment. If 12-lead indicated LV involvement occurring with hypotension that would place the Cardiogenic Shock and CPAP Directives out of parameters.

Crackles = no bolus, hypotension = no CPAP. Other than vitals/cardiac monitoring, oxygenation/ventilatory support as needed, it seems like a situation such as this one may limit pre-hospital management, as far as a PCP scope goes. Any comments or suggestions?

Question: I was going over the CPAP standing order today and would like clarification on whether the contraindication "Major trauma or burns to the head or torso" only means for a new occurrence or does it also include persons with prior existing major trauma or burns to head and torso?

Question: In regards to the CPAP medical directive, it states in the ALS PCS Companion document that CPAP is the treatment for Acute Pulmonary Edema (REGARDLESS of origin). Does this mean that the cause does not need to be cardiogenic in nature? Could you please elaborate on this?

Question: If a person have a near fresh water (lake water) drowning and Spo2 <90 % severe SOB, and by auscultating lungs I hear Crackles all over the places mainly on lower lobes tachypnea and normotensive. As per CPAP protocol: indication severe respiratory distress and signs and/ or symptoms of Acute pulmonary edema or COPD is the indication, and patient is above 18years and no contraindication met, can I apply CPAP on this patient ? If not please tell me why and I know Nitro is not applicable in this case because this is not a cariogenic pulmonary edema.

Question: I have been talking with my paramedic colleagues and I am wondering about the role of CPAP and aspiration. My understanding of the Medical Directive is that CPAP is not indicated for pneumonia or aspiration but rather severe SOB from either COPD or pulmonary edema. Can you please clarify the role of CPAP for respiratory distress patients with either pneumonia or aspiration as the underlying precipitating factor for their SOB?

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