1. Tired of seeing ads? Click here to register today and the ads go away. It's completely FREE, too!
    Dismiss Notice
  2. Can't find what you're looking for? Use the search bar in the upper right corner.
    Dismiss Notice


Discussion in 'ALS Discussion' started by philslat, Oct 21, 2018.

  1. medichopeful

    medichopeful NRP, ICU RN, CCRN, CEN

    My understanding (and of course, I could be wrong) is that mag isn't really useful for COPD, only asthma (due to the fact that in COPD, the damage/constriction is chronic. In asthma, the constriction is more acute, thus responds better to mag).

    I've only initiated CPAP once prehospitally on a COPD patient, and I can say that the improvement was drastic on just 5 of PEEP. Went from gasping to sleeping/resting (not the "oh crap" resting of a respiratory patient, a legitimate "oh, they look comfortable!").
    NPO likes this.
  2. NPO

    NPO Forum Deputy Chief

    I echo this.

    Mag helps to relax the bronchioles, but this is much more effective in asthmatics who have elasticity than COPDers who have very little elasticity left.

    I have used CPAP quite a bit prehospitaly (with disposable kits), and more recently have been using BiPAP via a ventilator. Both COPD and CHF patients tend to improve dramatically very quick. Some data I read recently in preparation for a CPAP presentation cited 90 seconds for notable improvement in many patients.

    Anecdotally, I've noticed CHF patients tend to have worse anxiety relating to CPAP, I assume it has to do with feeling like they are drowning. COPDers tend to have far better compliance with CPAP/BIPAP in my experience.
  3. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

    Where I work, I tend to be pretty aggressive with suggesting CPAP or BiPAP in the COPD exacerbation patient. Since I also know they can do in-line nebs, I will usually suggest that as well. It really is one of those "you'll know when you see it" kind of things. Most of the patients that I see only get breathing treatments, a steroid, and sometimes a mag infusion. It also doesn't take long to recognize when a patient isn't responding well to CPAP or BiPAP. If you see that, it's often a good idea to at least consider getting ready to intubate that patient.
  4. ZombieEMT

    ZombieEMT Chief Medical Zombie Premium Member

    Here in New Jersey, CPAP for BLS is pretty new. While many BLS agencies have it, it is not a state requirement yet. In the agencies that I work, our protocols are pretty specific. In suspected COPD patients, our protocol is to administer CPAP with a PEEP of 5, or 10 for suspected PE. I can say that I have applied CPAP for a COPD in severe distress. The unfortunate thing, is that the local ALS systems seem to think its not an option. The problem is their protocol generally calls for that albuterol/duo neb first, and CPAP almost as a last result. For BLS, that is our first and last resort (next to high flow oxygen). New Jersey has finally allowed BLS to "assist" with a prescribed neb but not to carry, meaning CPAP is normally a good option for us.
  5. DrParasite

    DrParasite The fire extinguisher is not just for show

  6. truetiger

    truetiger Forum Asst. Chief

    Critical Care EMT-P
    Perfect subset of patients to use BiPAP in.......we carry the ReVel vent and use it quite often.

Share This Page