developed by: lynn wittwer, md, mpd marc muhr, emt-p tj bishop, emt-p clark county ems
DESCRIPTION
Continuous Positive Airway Pressure (CPAP) Washington State Department of Health EMT Basic Curriculum. Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS Keith Wesley, MD, EMS Medical Director State of Wisconsin. CPAP Curriculum – EMT Basic. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/1.jpg)
Continuous Positive Airway Pressure (CPAP)
Washington State Department of HealthEMT Basic Curriculum
Developed by:Lynn Wittwer, MD, MPD
Marc Muhr, EMT-PTJ Bishop, EMT-PClark County EMS
Keith Wesley, MD, EMS Medical DirectorState of Wisconsin
![Page 2: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/2.jpg)
2Washington EMT-B CPAP Curriculum
CPAP Curriculum – EMT Basic
IntroductionReview of Anatomy and PhysiologyCPAP OverviewPulse OximetryReview of Respiratory DistressTreatment With CPAP
![Page 3: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/3.jpg)
3Washington EMT-B CPAP Curriculum
What is CPAP?
Continuous Positive Airway Pressure (CPAP)A non-invasive alternative to intubationDoes not require any sedationIt provides comfort to the patient with acute respiratory distress by reducing work of breathing
![Page 4: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/4.jpg)
4Washington EMT-B CPAP Curriculum
Why CPAP?
Respiratory Distress is a common reason why people call 911!Established therapeutic alternativeEasily applied, easily discontinued
![Page 5: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/5.jpg)
5Washington EMT-B CPAP Curriculum
Key Points of CPAP
CPAP has been successfully demonstrated as an effective adjunct in the management of a variety of respiratory distress states.CPAP may prove to be a viable alternative in many patients previously requiring endotracheal intubation by prehospital personnel.
![Page 6: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/6.jpg)
6Washington EMT-B CPAP Curriculum
CPAP vs. Intubation
CPAP– Non-invasive– Easily discontinued– Easily adjusted– Use by EMT-B– Does not require
sedation– Comfortable
Intubation– Invasive– Usually don’t
extubate in field– Potential for
infection– Requires highly
trained personnel– Can require
sedation– Traumatic
![Page 7: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/7.jpg)
Review of Anatomy & Physiology
![Page 8: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/8.jpg)
8Washington EMT-B CPAP Curriculum
Elements of the Airway
UPPER AIRWAYNaresNasopharynxOropharynxTongueEpiglottis/GlottisVocal Cords
LOWER AIRWAYTrachea/EsophagusCarinaMain stem BronchiSecondary BronchiBronchiolesAlveoli
![Page 9: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/9.jpg)
9Washington EMT-B CPAP Curriculum
Upper Airway
![Page 10: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/10.jpg)
10Washington EMT-B CPAP Curriculum
PharynxNasopharynx– Uppermost portion of airway,
just behind nasal cavities– Nasal septum – Vestibule– Olfactory membranes– Sinuses
Oropharynx– Begins at the level of the
uvula and extends down to the epiglottis
– Opens into the oral cavity
![Page 11: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/11.jpg)
11Washington EMT-B CPAP Curriculum
Larynx
Three main functions:– Air passageway between the pharynx and
lungs– Prevents solids and liquids from entering the
respiratory tree– Involved in speech production
![Page 12: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/12.jpg)
12Washington EMT-B CPAP Curriculum
Larynx
An outer casing of nine cartilages– Thyroid cartilage– Cricoid cartilage
Only complete cartilaginous ring in the larynx– Epiglottis
Hyoid boneCricothyroid membraneVocal cords
![Page 13: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/13.jpg)
13Washington EMT-B CPAP Curriculum
Lower Airway
![Page 14: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/14.jpg)
14Washington EMT-B CPAP Curriculum
![Page 15: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/15.jpg)
15Washington EMT-B CPAP Curriculum
Lungs
Principal function is respirationAttached to heart by pulmonary arteries and veinsSeparated by mediastinum and its contentsBase of each lung rests on the diaphragmApex extends 2.5 cm above each clavicle
![Page 16: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/16.jpg)
16Washington EMT-B CPAP Curriculum
Pleural Cavity
A separate pleural cavity surrounds each lungTwo layers (visceral and parietal)Pleural space
![Page 17: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/17.jpg)
17Washington EMT-B CPAP Curriculum
Respiratory System - Physiology
The respiratory system functions as a gas exchange systemOxygen is diffused into the bloodstream for use in cellular metabolism
![Page 18: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/18.jpg)
18Washington EMT-B CPAP Curriculum
Respiratory System - Physiology
Wastes, including carbon dioxide, are excreted from the body via the respiratory system
![Page 19: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/19.jpg)
19Washington EMT-B CPAP Curriculum
Ventilation
Ventilation refers to the process of air movement in and out of the lungsThe volume of air moved in each breath is the tidal volumeThe volume still remaining in the chest after exhalation is the functional reserve capacity. FRC
![Page 20: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/20.jpg)
20Washington EMT-B CPAP Curriculum
Inspiration and Expiration
Inspiration– Chest wall expands– Lung space increases– Pressure gradient causes gas to flow into the
lungsExpiration– Chest wall relaxes– Elastic recoil causes thorax and lung space to
decrease in size– Pressure gradient created in thoracic cavity
causes air to move out of the chest
![Page 21: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/21.jpg)
21Washington EMT-B CPAP Curriculum
Pressure Changes During Inspiration and Expiration
![Page 22: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/22.jpg)
22Washington EMT-B CPAP Curriculum
Mechanics of Breathing
![Page 23: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/23.jpg)
23Washington EMT-B CPAP Curriculum
Mechanics of Respiration
![Page 24: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/24.jpg)
24Washington EMT-B CPAP Curriculum
Ventilation
The following must be intact for ventilation to occur:– Neurologic control to initiate ventilation– Nerves between the brainstem and the
muscles of respiration– Functional diaphragm and intercostal muscles– A patent upper airway– A functional lower airway– Alveoli that are functional and not collapsed
![Page 25: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/25.jpg)
25Washington EMT-B CPAP Curriculum
Diffusion
In order for diffusion to occur, the following must be intact:– Alveolar and capillary
walls that are not thickened
– Interstitial space between the alveoli and capillary wall that is not enlarged or filled with fluid
![Page 26: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/26.jpg)
26Washington EMT-B CPAP Curriculum
How does CPAP work
Splints the upper airway preventing collapseUses continuous oxygen flow with pressure to push air into the lungs and push the fluid into the bloodsteamRecruits alveoli that have collapsed
![Page 27: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/27.jpg)
27Washington EMT-B CPAP Curriculum
CPAP MechanismIncreases pressure within airway.Airways at risk for collapse from excess fluid are stented open.Gas exchange is maintainedIncreased work of breathing is minimized
![Page 28: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/28.jpg)
28Washington EMT-B CPAP Curriculum
Pulse Oximetry
Basic concept of Pulse Oximetry monitoring.– Objectively determines oxygenation status
when applied correctly.– Measures the hemoglobin saturation in the
bloodstreamvia red and infrared light, through the skin to the arterial bed.
![Page 29: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/29.jpg)
29Washington EMT-B CPAP Curriculum
Pulse Oximetry
Possible invalid readings– Low blood flow states, (i.e., shock states,
hypothermic, hypovolemia) may show an inaccurate low oxygenation percent.
– Carbon monoxide poisoning may show a false high percent reading.
– Anemias and oxygen capacity carrying diseases (i.e., sickle cell) may also show a false high reading.
– Fingernail polish, excessive grease and dirt, nail-tips, or gel nails may cause a false low reading.
![Page 30: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/30.jpg)
Review of Respiratory Distress
![Page 31: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/31.jpg)
31Washington EMT-B CPAP Curriculum
Respiratory DistressWork of Breathing– Respiratory rate greater than 25/minute– The presence of retractions and/or use of
accessory musclesAppearance = Mental Status– Pulse Oximetry < 94%– Effects of hypoxia and hypercarbia
indistinguishableCirculation/Skin Color– Severe cyanosis– Pallor and diaphoresis
![Page 32: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/32.jpg)
32Washington EMT-B CPAP Curriculum
Focused History and PhysicalAscertain the patient’s chief complaint that may include:– Dyspnea– Chest pain– Cough
ProductiveNon-productiveHemoptysis
– Wheezing– Signs of infection
Fever, chillsIncreased sputum production
![Page 33: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/33.jpg)
33Washington EMT-B CPAP Curriculum
HistoryPrevious experiences with similar/identical symptomsKnown pulmonary diagnosisMedication history– Current medications– Medication allergies– Pulmonary medications– Cardiac-related drugs
History of the present episodeExposure and smoking history
![Page 34: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/34.jpg)
34Washington EMT-B CPAP Curriculum
Pulmonary Edema – Congestive Heart Failure
Defined– Fluid which collects in the lung tissue and
alveoliSigns/Symptoms/Assessment– Anxious, Pale, Clammy, Dyspnea, Tachypnea,
Confusion, Edema, Hypertension, Diaphoretic– Rales, Ronchi, Tachycardia, JVD, Pink Frothy
Sputum, Cyanosis
![Page 35: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/35.jpg)
35Washington EMT-B CPAP Curriculum
Pulmonary Edema – Congestive Heart Failure
Signs/Symptoms/Assessment– Fatigue– Nocturia– Dyspnea on exertion– Paroxysmal nocturnal dyspnea– Chest Pain– Orthopnea
![Page 36: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/36.jpg)
36Washington EMT-B CPAP Curriculum
Pulmonary Edema – Congestive Heart Failure
Treatment– Focused history and physical exam– Complains of trouble breathing.
Airway control w/ adequate ventilationOxygenation
– Has a prescribed nitroglycerine available.Consult medical direction.Facilitate administration of nitroglycerine
– Baseline vital signs.– Reassess
![Page 37: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/37.jpg)
37Washington EMT-B CPAP Curriculum
Chronic Obstructive Pulmonary Disease (COPD)
Defined– Lung tissue loses elasticity secondary to
destruction of the alveoli (Emphysema)– Inflammation of the bronchial tree. Diagnosed
by productive cough which lasts at least three months a year for at least two consecutive years (Chronic Bronchitis)
– Any COPD patient may have both
![Page 38: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/38.jpg)
38Washington EMT-B CPAP Curriculum
Chronic Obstructive Pulmonary Disease (COPD)
Signs/Symptoms/Assessment– Exertional dyspnea– Productive cough/wheezing– Minor hemoptysis– Tachypnea/exertional muscle use– Pursed lip exhalation– May have coarse crackles– Accessory muscle use– Hyperexpansion of the thorax (diminished breath
sounds)– Excessive caloric expenditure
![Page 39: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/39.jpg)
39Washington EMT-B CPAP Curriculum
Chronic Obstructive Pulmonary Disease (COPD)
Signs/Symptoms/Assessment– Tachypnea, cyanosis, agitation, tachycardia,
hypertension– Confusion, tremor, stupor, apnea
![Page 40: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/40.jpg)
40Washington EMT-B CPAP Curriculum
Chronic Obstructive Pulmonary Disease (COPD)
Treatment– Focused history and physical exam– Complains of trouble breathing.
Airway control w/ adequate ventilationOxygenation
– Has a prescribed inhaler available.Consult medical direction.Facilitate administration of inhalerRepeat as indicated.
– Baseline vital signs.– Reassess
![Page 41: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/41.jpg)
41Washington EMT-B CPAP Curriculum
Asthma
Defined– Condition which causes the bronchi to
constrict making it difficult to exhale (air trapping)
– May be caused by allergic reactions and/or emotional distress
– The most serious form, status asthmaticus, is a true life-threatening emergency
![Page 42: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/42.jpg)
42Washington EMT-B CPAP Curriculum
Asthma
Signs/Symptoms/Assessment– Dyspnea, chest tightness, wheezing, and
cough– Obvious SOB, wheezing, accessory muscle
use, paradoxical respirations, hyperresonance, prolonged expiration
– Change in Mental Status: agitation, confusion, lethargy, exhaustion
– Cardiac Arrhythmias
![Page 43: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/43.jpg)
43Washington EMT-B CPAP Curriculum
AsthmaTreatment– Focused history and physical exam– Complains of trouble breathing.
Airway control w/ adequate ventilationOxygenation
– Has a prescribed inhaler available.Consult medical direction.Facilitate administration of inhalerRepeat as indicated.
– Baseline vital signs.– Reassess
![Page 44: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/44.jpg)
44Washington EMT-B CPAP Curriculum
Pneumonia
Defined– Inflammation of both the bronchioles and
alveoli– May be viral, bacterial, or fungal. Spread by
droplets or contact with infected person– Common cause of death in North America
![Page 45: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/45.jpg)
45Washington EMT-B CPAP Curriculum
Pneumonia
Signs/Symptoms/Assessment– Acute onset of chills, fever, dyspnea, pleuritic
chest pain, cough, adventitious breath sounds.
– In geriatric patients, the primary sign may be an altered mental state.
![Page 46: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/46.jpg)
46Washington EMT-B CPAP Curriculum
PneumoniaTreatment– Focused history and physical exam– Complains of trouble breathing.
Airway control w/ adequate ventilationOxygenation
– Has a prescribed inhaler available.Consult medical direction.Facilitate administration of inhalerRepeat as indicated.
– Baseline vital signs.– Reassess
![Page 47: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/47.jpg)
Treatment with CPAP
![Page 48: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/48.jpg)
48Washington EMT-B CPAP Curriculum
Essential Components Of A CPAP System
1. CPAP Control Unit
![Page 49: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/49.jpg)
49Washington EMT-B CPAP Curriculum
Essential Components Of A CPAP System
2. Breathing Circuit and Positive Pressure Face Mask
![Page 50: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/50.jpg)
50Washington EMT-B CPAP Curriculum
Essential Components Of A CPAP System
3. Oxygen Source
![Page 51: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/51.jpg)
51Washington EMT-B CPAP Curriculum
Treatment With CPAPIndications– Patient in respiratory distress with signs and symptoms
consistent with: Congestive Heart Failure (CHF); Pulmonary Edema; asthma; COPD; or pneumonia
– Other measures to improve oxygenation and decrease the work of breathing have failed (i.e., 100% O2 via NRM)
– And who is:Awake and able to follow commands;Is over 12 years of age and is able to fit the CPAP mask;Has the ability to maintain an open airway;
– AndExhibits two or more:
– RR > 25 BPM– SPO2 <94% at any time– use of accessory muscles of breathing
![Page 52: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/52.jpg)
52Washington EMT-B CPAP Curriculum
Treatment With CPAP
Contraindications– Patient is apneic– Patient is suspected of having a
pneumothorax– Patient is a trauma patient with injury to the
chest– Patient has a tracheostomy– Patient is actively vomiting or has upper GI
bleeding
![Page 53: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/53.jpg)
53Washington EMT-B CPAP Curriculum
Treatment With CPAP
Procedure– Note indications and absence of
contraindications– Equipment:
CPAP machineCPAP mask, peep valves and strapsO2 Source Pulse Oximetry
![Page 54: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/54.jpg)
54Washington EMT-B CPAP Curriculum
Treatment With CPAP
Procedure (cont.)– EXPLAIN THE PROCEDURE TO THE PATIENT– Ensure adequate oxygen supply to the CPAP device– Place patient on continuous pulse oximetry– Position head of bed at 45 degrees or patient position
of comfort– Place CPAP mask over mouth and nose, secure with
straps provided– Use 5 cm H2O of PEEP– Check for air leaks
![Page 55: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/55.jpg)
55Washington EMT-B CPAP Curriculum
Treatment With CPAPProcedure (cont.)– Monitor and document the patient’s respiratory response to
treatment– Check and document vitals signs every 5 minutes– Assist with appropriate PATIENT PRESCRIBED medication
(nitroglycerin tablets for CHF, nebulized Albuterol for COPD/Asthma)
– Coach patient to keep mask in place, readjust as needed– Contact Medical Control and / or responding ALS unit to advise
of CPAP initiation– Request ALS intercept if available– If respiratory status deteriorates, remove device and consider
IPPV via BVM
![Page 56: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/56.jpg)
56Washington EMT-B CPAP Curriculum
Treatment With CPAP
Patient improvement indicated by:– Improvement in dyspnea – Decreased respiratory rate– Improved pulse oximetry– Improved patient comfort
![Page 57: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/57.jpg)
57Washington EMT-B CPAP Curriculum
Treatment With CPAP
Removal– CPAP needs to be continuous and should not be
removed unless the patient cannot tolerate the mask or experiences respiratory arrest and/or begins to vomit
– Intermittent positive pressure ventilation (IPPV) with a BVM should be considered if CPAP is removed
– A Laryngo Tracheal Device (King Airway, Combitube, etc.) should be used with a bag valve device if the patient is in respiratory arrest
![Page 58: Developed by: Lynn Wittwer, MD, MPD Marc Muhr, EMT-P TJ Bishop, EMT-P Clark County EMS](https://reader036.vdocuments.mx/reader036/viewer/2022081420/56815c69550346895dca7c28/html5/thumbnails/58.jpg)
58Washington EMT-B CPAP Curriculum
Treatment With CPAP
Special Considerations – Do not remove CPAP until hospital therapy
is ready– Watch for gastric distention which can cause
vomiting– CPAP may be used with patients who have
POLST forms or DNR orders