CPAP use

[billy]

Is anyone using CPAP in the field for treating acute CHF patients. I need some supporting info. prior to making a proposal to the Medical Director. Any help is appreciated.

[Trauma_Dog]

Billy look under my message titled galveston ems, it has some info about cpap. if you need more just write me.

[Ed]

Brown County Wisconsin (Green Bay Area) has just implimented CPAP in the new protocols and it is as follows:
Equipment: Prepacked Cpap unit consisting of mask, tubing, reservoir bag and PEEP valve.
Method: The CPAP unit is attached to high flow o2 at 15L/min. Mask is fitted to pts face snugly. Set PEEP valve to 5-10 cm H2O, the object is to keep the reservoir bag fully inflated (creates continuous positiver airway pressure) during both inspiration and expiration. Increase O2 flow to keep the reservoir bag fully inflated, may have to reassure the pt. initially as it is somewhat frightening and difficult to breathe with constant airway pressure. As the patient improves they usually become more accepting of the device.
Indications: All patients with severe pulmonary edema at risk for ventilatory failure. Patient needs to be able to communicate. A trial of CPAP is indicated for these patients and many times will prevent intubation.

That is our protocol and a few squads have already tried it most report that the patient doesn't like it at all but time will tell. I think it beats a severe nosebleed from a nasal intubation any day. Good luck.

[DemonMedic]

Lawrence & Memorial Hospital Paramedics in New London, CT have been using CPAP for over a year now. It has been very successfull. I don't have any hard statitistics as of yet, but it seems to have reduced the number of intubations, and increased pt improvement over just NTG lasix MS intubation, etc. They are working on revising their protocol, however the new proposed protocol states that it can be used on any acute pulmonary edema pt (ie CHF) that has a BP greater than 90 systolic, is conscious and able to speak. It goes along with the other APE tx that I mentioned above. They use a plug in flow generator which means the ambulance has to have a functioning inverter. They then hook the pt circuit up to the generator and fit a mask snuggly to the pt face, and supply O2 via an inline O2 adapter. Most pts seem to tolerate it very well, they have even had a few pts that wouldn't tolerate a NRB that tolerated the CPAP mask well. Hope this helps, if you need any more info email me and I can get you intouch with a friend who has more data.

Damian Rickard
NREMT-P
drickard@99main.com