Category Archives: CPAP

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?

Question: My question is in regards to pneumonia and continuous positive airway pressure (CPAP). Bacterial infections are a common trigger for chronic obstructive pulmonary disease (COPD) exacerbations.

If we have a patient who has possibly developed a pneumonia (isolated crackles mid lobe in one lung, low grade fever, purulent sputum) but is in respiratory distress with a history of COPD and is showing signs of a COPD exacerbation (decreased breath sounds in bases, showing signs of hypoxia, accessory muscle use, tachypnea, mild diffuse exp wheezes), are we not to treat with CPAP and just use bronchodilators and high flow O2? Thank you!

Question: We are instructed to get the nitro in, if applicable, apply the CPAP and if there is improvement, do not remove the mask for additional nitro sprays. Is the improvement slight or significant? If slight improvement, do we leave the pressure at the slight improvement pressure or titrate 2.5cmH2O?

Question: If respirations are at or above 28, historically paramedics are taught to assist via BVM. What is the rationale with pulmonary edema to apply NRB with tachypnea instead of assisting with a BVM until CPAP and or nitro is prepared?

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