PEEP in BLS?

NysEms2117

NysEms2117

ex-Parole officer/EMT
Messages
1,946
Reaction score
910
Points
113
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
 
NysEms2117 said:
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
Click to expand...
Not widely used in BLS. VERY rare. Maybe in a rural area or Intermediate rig.

Sent from my SM-G920P using Tapatalk
 
NysEms2117 said:
are PEEP(Positive end-expiratory pressure) valves commonly used in BLS? Are they allowed to be used in BLS?
Click to expand...

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...
 
EpiEMS said:
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...
Click to expand...
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

Sent from my SM-G920P using Tapatalk
 
I can not think of any situation in which you would use a PEEP valve and it not be ALS.
 
EpiEMS said:
Heck, if we can use CPAP (in many places) we can certainly put a little PEEP valve on our BVMs...
Click to expand...
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.
 
gonefishing said:
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

Sent from my SM-G920P using Tapatalk
Click to expand...

L.A. County scares me...

Chase said:
I can not think of any situation in which you would use a PEEP valve and it not be ALS.
Click to expand...

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).

VentMonkey said:
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.
Click to expand...

Certainly can't disagree! That's a matter for training -- I always say that I'd like more BVM practice!
 
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.
 
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.
 
In resuscitation, how concerned should we be about downsides of PEEP (e.g. barotrauma)?
 
EpiEMS said:
In resuscitation, how concerned should we be about downsides of PEEP (e.g. barotrauma)?
Click to expand...

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.
 
Summit said:
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.
Click to expand...

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.
 
@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?
 
EpiEMS said:
@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?
Click to expand...

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?
 
E tank said:
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?
Click to expand...
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.
 
EpiEMS said:
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.
Click to expand...

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.
 
E tank said:
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.
Click to expand...

Our protocols actually recommend a high volume low rate (10-12ml/kg at 6-8) for hypotensive patients, most often trauma.
 
You must log in or register to reply here.
Back
Top