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PEEP in BLS?

Discussion in 'BLS Discussion' started by NysEms2117, Dec 18, 2016.

  1. NysEms2117

    NysEms2117 Parole officer/EMT

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    Im an EMT-B, but do not ride on a BLS rig, are PEEP(Positive end-expiratory pressure) valves commonly used in BLS? Are they allowed to be used in BLS? I've seen countless videos of how PEEP is helpful, if used PROPERLY.


    ~Andrew
     
  2. NomadicMedic

    NomadicMedic formerly DEmedic

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    Yes. We have a PEEP valve on all of our BVMs.
     
    akflightmedic likes this.
  3. gonefishing

    gonefishing Forum Deputy Chief

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    Not widely used in BLS. VERY rare. Maybe in a rural area or Intermediate rig.

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  4. gonefishing

    gonefishing Forum Deputy Chief

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    For the life of me was thinking vents!

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  5. EpiEMS

    EpiEMS Forum Deputy Chief

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    While I wouldn't be surprised if some states have restrictions on the use of PEEP valves for BLS providers, I do generally believe that they are considered acceptable for BLS use. Heck, if we can use CPAP (in many places) we can certainly put a little PEEP valve on our BVMs...
     
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  6. gonefishing

    gonefishing Forum Deputy Chief

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    Alot of places don't even allow the use of cpap at the bls level. Such as L.A. County. Things are much the same as they were in 1970. They just allowed emts to use pulse oximetry last year lol

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  7. Chase

    Chase Flight Nurse

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    I can not think of any situation in which you would use a PEEP valve and it not be ALS.
     
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  8. VentMonkey

    VentMonkey Crackpot Premium Member

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    They're achieving the same end-goal. Our CCT division has them, I leave one where I can grab it in our airway bag next to our BVM's, but do still admittedly forget, or the patient is already being bagged while I am setting stuff up; a habit I am trying to break.

    Our ground division does not carry them, though I wish that they did, as well as our fire first responders.

    But, more important than the importance of these nifty little buggers would be proper delivery of ventilations , and subsequently oxygenation. Even without them, an excellent bag-mask technique is most definitely more important, IMHO.
     
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  9. VentMonkey

    VentMonkey Crackpot Premium Member

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    The end of a (BLS) BVM.
     
  10. EpiEMS

    EpiEMS Forum Deputy Chief

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    L.A. County scares me...

    Absolutely, but there's no reason not to have them on your BLS units (if they might happen upon a patient who'd need PPVs prior to ALS arrival).

    Certainly can't disagree! That's a matter for training -- I always say that I'd like more BVM practice!
     
  11. E tank

    E tank Forum Captain

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    I'd think it would be next to impossible to maintain any meaningful PEEP with a mask. That'd be some pretty wicked mask ventilation skills.
     
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  12. Remi

    Remi Forum Deputy Chief Premium Member

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    As was very recently discussed in another thread, PEEP is a good idea any time you are providing positive pressure ventilation.

    It isn't any harder to provide good mask ventilation with a PEEP valve than it is without it. I can't think of any reason why BLS personnel would be expected to be able to provide good mask ventilation, but not be able to use a PEEP valve.
     
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  13. EpiEMS

    EpiEMS Forum Deputy Chief

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    In resuscitation, how concerned should we be about downsides of PEEP (e.g. barotrauma)?
     
  14. Summit

    Summit Critical Crap

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    PEEP valve on a BVM giving you 10 of peep is not going to cause overpressure injury. It is far more likely bad technique (overinflation) would do that which is prevented with training and a pop-off valve.
     
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  15. E tank

    E tank Forum Captain

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    Agreed...volu/barotrauma is just that...unnecessarily high volumes/pressures for the condition. PEEP only contributes inasmuch as it affects the mean airway pressure...all that said, in low flow, low venous return states like any type of shock or resuscitation, laying off the PEEP and keeping low tidal volumes will promote whatever cardiac output you have to work with.
     
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  16. EpiEMS

    EpiEMS Forum Deputy Chief

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    @Summit and @E tank, much appreciated. So it sounds like PEEP is most useful in such situations as CPAP is, but at the point where you have to transition away from CPAP to PPVs, right? Like when your acute asthmatic decompensates to the point where they need PPV rather than NIPPV?
     
  17. E tank

    E tank Forum Captain

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    So are you saying that, in general, CPAP is for spontaneous ventilation and PEEP for positive pressure/mechanical ventilation? If so, then yes, that's correct. Am I following you?
     
  18. EpiEMS

    EpiEMS Forum Deputy Chief

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    Yeah, I suppose my question answered itself - if a patient with a complaint that (in a conscious, able to maintain their airway patient) would get CPAP goes unconscious/becomes unable to maintain their airway, PPV with PEEP would be acceptable.
     
  19. E tank

    E tank Forum Captain

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    Generally speaking, yes. But like I said before, if a low/no blood flow state were to exist, you'd leave off the PEEP and use "smaller" tidal volumes because of the potential to further decrease venous return to the heart.
     
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  20. Chase

    Chase Flight Nurse

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    Our protocols actually recommend a high volume low rate (10-12ml/kg at 6-8) for hypotensive patients, most often trauma.
     

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