CPAP: When To Pull The Trigger

[the_negro_puppy]

BLS & ALS here has no CPAP :wacko:

 

[fast65]

BLS & ALS here has no CPAP :wacko:

That's kinda odd


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[SanDiegoEmt7]

Here CPAP is used for severe respiratory distress in asthmatics, COPD, and CHF. Being that it's only or severe SOB, it's always used in conjunction with meds, because at that point we are generally giving them almost everything we have. Whether it's nitro, albuterol, Epi, mag sulfate, etc.

We don't have RSI or MFI. It's a great device. I've seen it do wonders for patients.

 

[BandageBrigade]

I'm kind of shocked by the number that do not or cannot use for asthma and do not use in-line nebs

 

[rhan101277]

I bet CPAP isn't to effective at high pulmonary blood pressures.

 

[Smash]

I'm kind of shocked by the number that do not or cannot use for asthma and do not use in-line nebs

I don't see why you would be shocked when you consider the dearth of good evidence for CPAP in asthma.

 

[Shishkabob]

I'm kind of shocked by the number that do not or cannot use for asthma and do not use in-line nebs

That's the thing, we have inline nebs with A&A with CPAP in COPD exacerbation, but not asthma, when in reality, asthma and COPD aren't too dissimilar.

 

[BandageBrigade]

I don't see why you would be shocked when you consider the dearth of good evidence for CPAP in asthma.

But the evidence is there. Much of it is newer, but it shows to be much more effective than originally tonight. I will have to post some of the studies after I get off work.

 

[Handsome Robb]

What meds are they missing?


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There's no defascultating dose of vec when sux is used as the paralytic, there's no atropine to prevent bradycardia, however it can be considered if the patient becomes bradycardic and there's no lidocaine used in patients with suspected increased ICP/head injury.

They can give Midazolam OR Etomidate, then Fentynal, can attempt intubation at this point or move to Succinylcholine OR Vecuronium. Then Vecuronium for continued paralysis.

I know the fent can combat spikes in ICP.

So I guess it is actually an RSI. h34r:

 

[usalsfyre]

Defac doses, atropine in adults and lido for ICP are all in doubt/have been disproven. The only thing I saw that was weird is the fent and etomidate are backwards.

 

[Shishkabob]

Atleast they are stupid to the point of allowing Etomidate but no paralytic like some places.

 

[Handsome Robb]

Atleast they are stupid to the point of allowing Etomidate but no paralytic like some places.

:unsure: I don't quite understand what your getting at.

 

[Shishkabob]

:unsure: I don't quite understand what your getting at.

Some places think Etomidate and etomidate only without a paralytic as a backup constitutes as a 'smart idea' and 'PAI'. Etomidate is well known to cause trismus on occasion... and if you don't have a paralytic to combat it, your patient is screwed.



Sure, just etomidate can work at times, and can actually be a good idea if you're fearful of a tougher intubation than normal and dont want to risk the paralysis, but if you have no backup aside from cutting a hole in their neck, you're in a world of hurt when they finally lock down. My second RSI, I tried to just do etomidate without Roc, and he locked down. Luckily I had the fore-site of having my Roc already pulled up just in case. Gave it, loosened up, got the tube and all was good.


PS--- I originally meant "aren't" stupid, not are. My bad!

 

[Fish]

I am personally pretty liberal when it comes to CPAP(given the patient has no contraindications to it)

CPAP is a wonderful tool that works very well, and in a lot of areas is listed as a BLS skill.

 

[systemet]

Regarding etomidate (-succinylcholine), here's an abstract for a study comparing etomidate alone versus etomidate + sux for intubation by a HEMS system.

They had to use "rescue succinylcholine" in 11% of patients given etomidate alone.






-----------------
Am J Emerg Med. 2000 Nov;18(7):757-63.
Etomidate versus succinylcholine for intubation in an air medical setting.
Kociszewski C, Thomas SH, Harrison T, Wedel SK.
Source

Boston Medflight Critical Care Transport Service, MA, USA.
Abstract

The objective was to compare rates of successful endotracheal intubation (ETI) and requirement for multiple ETI attempts in patients receiving etomidate (ETOM) versus succinylcholine (SUX). This retrospective study analyzed adults in whom oral ETI was attempted by a helicopter EMS (HEMS) service between July 1997 to July 1999. Data were from records of the HEMS service, which uses a RN/EMTP crew; analysis was with chi-square and logistic regression (P = .05). ETI was successful in 269 (97.8%) of 275 patients, with multiple attempts occurring in 54 (20.1%) of 269. Success rates for SUX (209 of 213, 98.1%) and ETOM (60 of 62, 96.8%) were similar (P = .62). However, of 60 ETOM patients successfully intubated, 7 (11.7%) required rescue succinylcholine. When these patients are tallied as ETOM failures and SUX successes, resultant success rates for ETOM (86.9%) and SUX (98.2%) are different (P = .001). ETOM patients were more likely (P = .004) than SUX patients to require multiple attempts (33.3% versus 16.3%). ETI success rates were high in patients receiving SUX or ETOM as primary adjuncts for airway control, but initial success was more likely with SUX, and ETOM patients were more likely to require multiple attempts.

PMID:
11103724
[PubMed - indexed for MEDLINE]

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