CPAP - Frequency of Use

[EpiEMS]

How often do you find yourself using CPAP?

Also, regarding CPAP, seeking any tips and tricks -- CT is rolling out BLS CPAP, and I'm quite excited, but I have little experience with it, given that it's not exactly an extremely common BLS skill (yet).

 

[VentMonkey]

How often do you find yourself using CPAP?
I don't use it as frequently anymore as when I worked regular 911 shifts full time, and even then it seemed to come out typically more seasonally, and/ or after a huge dust storm.

Occasionally, we'll catch that non-compliant CHFer, or patient who's skipped dialysis for a week, and had a salty meal, or six.

I personally think some people in our system are/ were scared off by how complicated it looks to place, and perhaps this has caused them to shy away from it which is a shame really, because if and when properly placed, it works wonderfully. Thankfully most of our newer paramedics have been taught it's relevance.

Also, regarding CPAP, seeking any tips and tricks -- CT is rolling out BLS CPAP, and I'm quite excited, but I have little experience with it, given that it's not exactly an extremely common BLS skill (yet).

This will depend on which device your service provides/ purchases. We have the Pulmodyne, which is a very quick, and easy set up. When I last spoke with our head supply tech, I was told they (Pulmodyne) were phasing out our current mask in favor of their newer model which comes with a port, and chamber to allow in-line breathing treatments.

All in all, it is a pretty straightforward skill, that again, I feel should be at the BLS level in each and every state.

 

[akflightmedic]

I use CPAP every single night!

 

[NomadicMedic]

Just practice with it until you're 100% comfortable with putting it together and adjusting the straps for a tight seal. It's really easy and it's probably the best tool to be added to the EMS tool box in years.

 

[VentMonkey]

I use CPAP every single night!

Lol, well played, sir. This made me chuckle.

 

[TransportJockey]

As a service, we tend to use it somewhere between a quarter and a third of our true respiratory patients. But we have a large percentage of patients w chronic respiratory problems that call us when they go into extremis

 

[aquabear]

As a medic (sorry, not a tip the OP could use as a basic), we give a small dose of ketamine (25mg IV or 50mg IM) to help calm down the PT without knocking out their respiratory drive, which is a pesky side effect of using benzos for the same purpose. Also, don't be afraid to increase PEEP if you have that ability with your CPAP set up.

 

[EpiEMS]

This will depend on which device your service provides/ purchases. We have the Pulmodyne, which is a very quick, and easy set up. When I last spoke with our head supply tech, I was told they (Pulmodyne) were phasing out our current mask in favor of their newer model which comes with a port, and chamber to allow in-line breathing treatments.

All in all, it is a pretty straightforward skill, that again, I feel should be at the BLS level in each and every state.

It certainly seems straightforward. The one our ALS colleagues use is quite straightforward - and it's the one we'll be using, albeit without the option to administer breathing treatments.

I use CPAP every single night!

A ringing endorsement!

As a service, we tend to use it somewhere between a quarter and a third of our true respiratory patients. But we have a large percentage of patients w chronic respiratory problems that call us when they go into extremis

That's quite a lot -- do you find it helps to prevent/forestall the need to intubate?

QUOTE="aquabear, post: 619713, member: 11627"]As a medic (sorry, not a tip the OP could use as a basic), we give a small dose of ketamine (25mg IV or 50mg IM) to help calm down the PT without knocking out their respiratory drive, which is a pesky side effect of using benzos for the same purpose. Also, don't be afraid to increase PEEP if you have that ability with your CPAP set up.[/QUOTE]

Here's hoping I can give IN ketamine someday
It seems like we're going to be limited to 10cm H20 by protocol (new protocols), and I think that's fairly standard? (Please correct me if I'm wrong!)

 

[aquabear]

Most disposal CPAP systems only go up to 10mmH2O, just some people forget to increase it from the lowest setting. It all depends on what CPAP you are using, some are adjustable and others are set to a fixed pressure.

 

[VentMonkey]

That's quite a lot -- do you find it helps to prevent/forestall the need to intubate?

Yes, undoubtedly. This goes across the board regardless of the system you work in. Like DEmedic said, definitely the best tool in our arsenal as of late. Kinda like ASA for AMI/ ACS.

The turnaround you will see on some of these patients is remarkable, and can be as remarkable as say a Narcan OD, or diabetic reversal, though perhaps not as instantaneous.

While BiPap is much more comfortable (EPAP allowing them to exhale), CPAP is a perfect tool for ANY prehospital providers toolkit.

 

[EpiEMS]

Most disposal CPAP systems only go up to 10mmH2O, just some people forget to increase it from the lowest setting. It all depends on what CPAP you are using, some are adjustable and others are set to a fixed pressure.

Ok -- thanks for the advice! I'm hoping that getting hands on will be helpful.

Yes, undoubtedly. This goes across the board regardless of the system you work in. Like DEmedic said, definitely the best tool in our arsenal as of late. Kinda like ASA for AMI/ ACS.

The turnaround you will see on some of these patients is remarkable, and can be as remarkable as say a Narcan OD, or diabetic reversal, though perhaps not as instantaneous.

While BiPap is much more comfortable (EPAP allowing them to exhale), CPAP is a perfect tool for ANY prehospital providers toolkit.

I'm really looking forward to using CPAP - I see more in the way of CHF and asthma exacerbations than, say, narcotic overdoses, so of our new skills, CPAP > IN naloxone. Thanks!

 

[VentMonkey]

Most disposal CPAP systems only go up to 10mmH2O, just some people forget to increase it from the lowest setting. It all depends on what CPAP you are using, some are adjustable and others are set to a fixed pressure.

Ours goes up to 15 cmH2O and our protocol actually calls for adjustments based on the patient's suspected working diagnosis, with 5 cmH2Obeing the lowest (COPD/ asthma), and 15 cmH2O being the max (acute/ NOS/ flash pulmonary edema), though our protocol states most CHF patients will tolerate ~10 cmH2O (first hand experience says that varies).

I don't know how comfortable most field providers are with proper recruitment strategies, though I do think having a working knowledge of this term and how it can apply to the different types of acute respiratory patients is an important concept to understand.

 

[DesertMedic66]

Here's hoping I can give IN ketamine someday
It seems like we're going to be limited to 10cm H20 by protocol (new protocols), and I think that's fairly standard? (Please correct me if I'm wrong!)

We can go up to 15cm H2O. Our system has the ability to go up to 20cm H2O however we have to get a base order for it.

 

[VentMonkey]

A base order, huh? Craziness. When I was a paramedic intern REMS still had pediatric intubation, NTI, and hardly anything was a BHO.

I liked the layout of their protocols, too. A very simple to understand, and orderly sequence.

 

[DesertMedic66]

A base order, huh? Craziness. When I was a paramedic intern REMS still had pediatric intubation, NTI, and hardly anything was a BHO.

I liked the layout of their protocols, too. A very simple to understand, and orderly sequence.

Base order just to go up to 20cm H2O. Everything else CPAP related is standing orders.

 

[TransportJockey]

That's quite a lot -- do you find it helps to prevent/forestall the need to intubate?

Somewhat, yes. As long as they can follow directions. Keep in mind our numbers are also skewed a bit because we work a fair amoung of drownings and near drowninhs, and our practice tends to lean toward using cpap on those patients early on in the process

Sent from my SM-N920P using Tapatalk

 

[VentMonkey]

While we're on the topic of CPAP:

Has anyone had any experience, knowledge, or luck with using it to splint a flail segment?

Apparently, while not routine, it can, and has been done for these patients, and is supposed to work quite well given the patient selected is young, and healthy enough to tolerate it.

We went over this in my CCP course, and just wondered if anyone on the forum has any working knowledge of this, thanks.

 

[STXmedic]

As a medic (sorry, not a tip the OP could use as a basic), we give a small dose of ketamine (25mg IV or 50mg IM) to help calm down the PT without knocking out their respiratory drive, which is a pesky side effect of using benzos for the same purpose. Also, don't be afraid to increase PEEP if you have that ability with your CPAP set up.

How is that working for you? In my personal experience, sub-dissociative doses of ketamine tend to be anxiety-provoking most of the times I've given it. They'll stop complaining about the pain, but will get visibly anxious, occasionally diaphoretic, and tachycardic (that seems more pronounced and related to the anxiety as opposed to the typical symptathomimetic response ketamine elicits). So I'm curious to see if you've used it personally and to what effect.

 

[RocketMedic]

We are burning crazy amounts of oxygen with our Pulmodyne yellow boxes. A portable tank has a lifetime of 3-4 minutes with ours, and a main is dead in 30 minutes. Not sure if it's normal function, but administration refuses to consider alternatives...

 

[VentMonkey]

we have a large percentage of patients w chronic respiratory problems that call us when they go into extremis

Would you mind elaborating for others the rationale behind using it in this specific patient subset?

This definitely sounds like a teachable moment.