Pulmonary Edema & PEEP

[Trauma_Dog]

I have read most of the forums on the chf issues over the last few days and I did not hear much about PEEP (positive end exspiratory pressure) hope I spelled that right.Anyway I have had very good luck with the use of peep and even had some frequent fliers who ask for it. It can be used with a w/o intubation. Just wondering how many out there are using it?

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[crossfire]

Sorry, There's no help here!! The closest are EMS system comes to providing PEEP are those little marshmellow Easter candies.

I am interested in how and when you use this theraphy.

I have used it before but only in a hospital setting with ventilators.

Thanks

[emsbrando]

The use of PEEP has been around for years in pre-hospital care, and is really a basic EMT skill, that's where I learned it. What you do is get a mouthpiece from an RT at the hospital, and when you get a patient with CHF, and they have rales, along with SOB, you put the mouthpiece on the end of a demand valve, and have them suck on it and breath normally, and NOT touch any of the buttons.

The one-way diaphram on the demand valve will let the oxygen in with a little force, and it will relieve most if not all of the atelectecis by expanding the lungs.

I've seen patients that were cyanotic pink up within minutes. It's great. Unfortunately most of the new paramedics are quick to start using nitro, lasix, albuterol, and such, but I would rather use the PEEP first.

Ed Brando, NREMT-P
Regional Director, ETMC/EMS
Firefighter, Carthage VFD

[Paramark14]

We don't use PEEP (yeah, you did it right).All I know about it is what I learned in medic class, I'd really like to hear more about it from those who use it. Any info I get I'll take to my MD.

Mark
NREMTP
Indiana

[firemedic1979]

If you are looking for pre-hospital avoidence of intubation, see if you can get trained on BiPap/Cpap.

It works on the same principle, the machines are small enough for transport service.

Many patients are sent home with the units.

I have seen it in the ER's, but do not field use it (budget).

[Trauma_Dog]

TO CLEAR THIS UP SOME. I USE THIS IN CONJUCTION WITH INTUBATION. THE VALVE FITS ON A PORT OF THE BVM WHICH HAS A COVER THAT JUST POPS OFF (WE USE THE AMBU BAG). CPAP AND BIPAP ARE ALSO EFFECTIVE AND LESS INVASIVE, HOWEVER I HEAR THOSE UNITS ARE OXYGEN HOGS AND NEED SOME FINE TUNING. I WOULD LIKE TO TRY CPAP, A LOCAL AGENCY (GALVESTON EMS) DID A STUDY AND EVEN HAD IT PUBLISHED IN JEMS, WHICH SHOW SOME STAGGERING STATS. ANYWAY THANKS FOR THE RESPONSE.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX