EMS use of CPAP for respiratory emergencies
The use of continuous positive airway pressure, commonly called CPAP, for the emergency management of congestive heart failure is rapidly becoming the new standard of care, replacing the traditional approaches of nitrates, diuretics and invasive airway management. As CPAP becomes more commonplace, more uses for the technology have emerged.
Positive pressure: a brief review
Within the alveolus is a liquid called surfactant, which reduces water surface tension within the space and keeps the alveolus open. Excess fluid from heart failure will disturb this balance, causing the alveoli to collapse and gas exchange to be compromised.
CPAP forces a small amount of air pressure through the pulmonary tree and into the alveoli, causing them to reopen. Additionally, the increased intrathoracic pressure will also reduce the patient's hypertensive state, allowing the fluid shift to occur more easily.
The pressure created by CPAP is held constant throughout the breathing cycle; the patient will feel a small amount of "back pressure" during the exhalation phase.
Mainstay of heart failure treatment
It remains important to carefully monitor a patient's blood pressure prior to and during CPAP treatment. CPAP is not indicated for pulmonary edema secondary to cardiogenic shock.
Additionally, patients must be able to follow simple commands and have adequate ventilation ability in order to use CPAP.
Several CPAP devices also allow bronchodilator medications to be nebulized and administered simultaneously with consistent and continuous positive pressure. Evaluate your CPAP supplies because an integrated nebulizer port is an additional feature and not available on every system.
2. Toxic inhalation
Even larger airways, such as the main bronchioles, can be affected by smoke and other combustion byproducts.CPAP may offer relief in these situations.
4. Flail chest
Positive pressure ventilation through a bag-mask device requires training and careful use with such a spontaneously breathing patient. CPAP may provide better control of tidal volume in these circumstances.
5. Lung infections
CPAP appears to help improve gas diffusion in these cases, possibly by reducing inflammation of the cells and improving airflow to the alveoli.
Our understanding of CPAP and its uses in emergency field care will continue to expand as the technology develops and research continues. It will also become more widespread as the devices become less expensive.
It's clear that its use in heart failure is highly effective, giving the EMS provider a valuable tool in efforts to deliver high-quality care.
But there are other conditions that also appear to benefit from CPAP, making it a versatile technique to deploy quickly and easily in the field.
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8. Kallio T., Kuisma M., Alaspaa A., Rosenberg PH. The use of prehospital continuous positive airway pressure treatment in presumed acute severe pulmonary edema. Prehosp Emerg Care. 2003;7: 209–13.Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of "EMT Exam for Dummies," has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at Art.Hsieh@ems1.com and connect with him on Facebook or Twitter.
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