Respiratory emergency question

[jonpw52]

If he is CYANOTIC then you have to bag him. That means his breathing no matter what the rate, is inadquate.


_______________________

I NEED MEDICS, MEDICS!!!

 

[Shishkabob]

If he is CYANOTIC then you have to bag him.

No.

 

[WolfmanHarris]

If he is CYANOTIC then you have to bag him. That means his breathing no matter what the rate, is inadquate.

Incorrect.

 

[CAOX3]

If he is CYANOTIC then you have to bag him. That means his breathing no matter what the rate, is inadquate.


_______________________

I NEED MEDICS, MEDICS!!!

Ventilation and oxygenation are two different animals.

 

[jjesusfreak01]

Ill try to make this as simple as possible. At a basic level, you are probably not going to be able to consider the CPAP. So, that leaves us with NRB and BVM.

If the patient is breathing adequately, regardless of all else, they get an NRB. If the patient is breathing inadequately, then they get the BVM.

Adequate breathing has 2 components, rate and volume. You have to have both adequate rate and volume to be breathing adequately. Adequate rate can be as low as ~10 breaths per minute and as high as ~20. Adequate volume is indicated by good chest rise and fall.

Low rate (10) and good volume can be just fine, as can high rate(20) and moderate volume can be too. You should be able to simply look at a patient and very quickly know if their breathing is adequate or inadequate.

Note: If someone is breathing adequately and is cyanotic, how would hooking them up to a BVM help? They will be getting just as much oxygen as on an NRB.

 

[clibb]

If he is CYANOTIC then you have to bag him. That means his breathing no matter what the rate, is inadquate.


_______________________

I NEED MEDICS, MEDICS!!!

Annnnd if he's unresponsive you begin CPR too right?

Cyanotic just means give him oxygen. Sp02 lower then 90, then bag him. Patient could be Cyanotic due to a lot of different problems. But if it's due to lack of oxygen, then give him some!

Note: If someone is breathing adequately and is cyanotic, how would hooking them up to a BVM help? They will be getting just as much oxygen as on an NRB.

Wrong. With a BVM you fill the lungs (800cc but around 150cc of that is dead space) better and my sufficient then you would with a regular mask. Since you are pushing the air into the lungs. With a regular 15lpm mask, you're really not pushing any air into the patient's lungs.

Now if you have a patient that is 10 bpm and is cyanotic, you have a problem. You'll be able to see if he's struggling with the use of his accessory muscles.

IF. that's a really big IF. far too many people (in and out of hospital) look at the pulse ox and numbers, and fail to provide pts with proper care, bc "the number is 'normal' " - example of this is the pt my husband had 2 wks ago - older fm, resp distress, tripoding, normal color, etc... 98% RA. nurse in ER wants to know why pt is on oxygen "bc her sats are normal" - keep in mind pt is still tripoding....
yes, used properly, it can be great, but used at the expense of proper pt care....

The nurses asked why? Treat the patient not the machine. Since it's a female, if she had nail polish on it could misread the whole pulse ox. Also, oxygen is a courtesy

 

[jjesusfreak01]

Wrong. With a BVM you fill the lungs (800cc but around 150cc of that is dead space) better and my sufficient then you would with a regular mask. Since you are pushing the air into the lungs. With a regular 15lpm mask, you're really not pushing any air into the patient's lungs.

Now if you have a patient that is 10 bpm and is cyanotic, you have a problem. You'll be able to see if he's struggling with the use of his accessory muscles.

And that there would be one of the perfect indicated uses of the CPAP (anytime a person is breathing adequately through a NRB but you think they could still use more air), which basics cannot use. Sure, if a person isn't breathing quickly or deeply enough you can assist with a BVM and match their respirations, but honestly if they are already breathing adequately (and this is the only situation I am talking about) are you going to be able to get much more air into them than they can get from their own respirations? They bag and reservoir on the BVM only holds so much, and a patient breathing normally will probably take in most --> all of that, right? This is kind of a silly argument though because the situation you list is a clear CPAP case. If they are cyanotic with a NRB mask at 15lpm then you need to be looking for other serious causes while ALS is on the way, not worried about forcing respirations through the BVM.

 

[Shishkabob]

Erm... you don't use CPAP if they are "breathing adequately and just need more air"

 

[jjesusfreak01]

Erm... you don't use CPAP if they are "breathing adequately and just need more air"

You know what I mean. Respiratory distress where they may have ok tidal volume, good rate, but are a patient that could benefit from a higher volume. As well as of course the classic uses of CPAP prehospital like pulmonary edema.

When would you use the CPAP in a pre-hospital setting?

 

[clibb]

And that there would be one of the perfect indicated uses of the CPAP (anytime a person is breathing adequately through a NRB but you think they could still use more air), which basics cannot use. Sure, if a person isn't breathing quickly or deeply enough you can assist with a BVM and match their respirations, but honestly if they are already breathing adequately (and this is the only situation I am talking about) are you going to be able to get much more air into them than they can get from their own respirations? They bag and reservoir on the BVM only holds so much, and a patient breathing normally will probably take in most --> all of that, right? This is kind of a silly argument though because the situation you list is a clear CPAP case. If they are cyanotic with a NRB mask at 15lpm then you need to be looking for other serious causes while ALS is on the way, not worried about forcing respirations through the BVM.

To be honest with you I've heard that the CPAP aren't used that much anymore. Yeah, I've had a CPAP used on me just to try it out and it does force air into your lungs.
*If a person is breathing adequately, you should only be giving them oxygen through Nasal Cannula (2-6 LPM) or NRB (12-25 LPM)*
The BVM holds enough air to fill your lungs and to increase you Sp02 to 98% or above state.
If the person is Cyanotic, breathing adequately, and CONSCIOUS. I am going to put them on 15-25 lpm NRB, if that doesn't work (which would be very weird) I will BVM then against their will . Now if they are Cyantic, inadequate breaths and unconscious I'll use my BVM hooked up to oxygen.
With a CPAP it's easier to damage and/or hyperventilate a patient then it is with the BVM. Remember, machine determines pressure and rate while with the BVM you determine pressure and rate. At least with the CPAP I used in my class.

 

[Shishkabob]

There is so much wrong with this thread it's starting to hurt.

25lpm NRB?

Holds enough air to increase spo2 to 98%?

CPAP not used much anymore?

Bvm against their will if nrb doesn't work?


CPAP determines pressure and rate on it's own?

 

[clibb]

There is so much wrong with this thread it's starting to hurt.

25lpm NRB?

Holds enough air to increase spo2 to 98%?

CPAP not used much anymore?

Bvm against their will if nrb doesn't work?


CPAP determines pressure and rate on it's own?

We were taught we could do 12-25 lpm via nrb.
I've never see anyone do 25 lpm though, that would dry you out in no time.
With enough air to increase spo2 I meant that the BVM holds a close value of air that the lung does. I didn't mean like it was Miami Medical where you can increase spo2 from 88% to 98% with one puff.
CPAP is not used around here anymore is what I've been told. I've never seen it on any rigs that I've been on around here.
BVM against their will was a joke, hint the smiley face... I'm not a comedian, I know.

 

[WolfmanHarris]

People it's time to expand the depth of your education. It's apparent that there's a great deal of rote learning being applied incorrectly based on experience and misunderstanding.

Here are some concepts worth learning about at any level of training:
- Oxy-hemoglobin dissociation curve
- Acid-base balances
- FIO2 of various breathing devices (for example, what increase in approximate FIO2 can one expect by increasing flow rate from 10lpm to 25 lpm?)
- Positive End Expiratory Pressure (especially in regards to CPAP)
-Ventilation vs. oxygenation vs. perfusion

I am by no means an expert on respiratory care, but these concepts are absolutely vital to understanding how oxygen does and doesn't benefit patients.

 

[jjesusfreak01]

My instructor has gone on and on about how much he loves the CPAP for respiratory patients. I think primarily CHF and COPD patients, but also for pneumonia and asthma patients in my county. Can you think of a faster way to help a CHF patient suffering from pulmonary edema than nitro and a CPAP?

 

[CAOX3]

There is so much wrong with this thread it's starting to hurt.
25lpm NRB?

Holds enough air to increase spo2 to 98%?

CPAP not used much anymore?

Bvm against their will if nrb doesn't work?


CPAP determines pressure and rate on it's own?

That could be the understatement of the year!

 

[Cawolf86]

We should rename this thread - how not to handle a respiratory emergency.

 

[MrBrown]

People it's time to expand the depth of your education. It's apparent that there's a great deal of rote learning being applied incorrectly based on experience and misunderstanding.

Here are some concepts worth learning about at any level of training:
- Oxy-hemoglobin dissociation curve
- Acid-base balances
- FIO2 of various breathing devices (for example, what increase in approximate FIO2 can one expect by increasing flow rate from 10lpm to 25 lpm?)
- Positive End Expiratory Pressure (especially in regards to CPAP)
-Ventilation vs. oxygenation vs. perfusion

I am by no means an expert on respiratory care, but these concepts are absolutely vital to understanding how oxygen does and doesn't benefit patients.

+10 my Canadian friend!

 

[iamajammer]

My instructor has gone on and on about how much he loves the CPAP for respiratory patients. I think primarily CHF and COPD patients, but also for pneumonia and asthma patients in my county. Can you think of a faster way to help a CHF patient suffering from pulmonary edema than nitro and a CPAP?

I could maybe understand the cpap for a CHF patient, but for COPD, probably not. Typically you would use a Bipap or no more than 28% O2 for your copd patient. The reason is, most COPD's have an obstructive component (emphysema), which basically causes you to air trap and retain high CO2 levels. A CPAP may help slightly, but you really want to ventilate these patients, not better oxygenate them.

As for a faster way to help a CHF patient, you would want to consider also giving lasix.

 

[MrBrown]

As for a faster way to help a CHF patient, you would want to consider also giving lasix.

*Brown taps his foot for twenty minutes waiting for the frusemide to work while watching the electrolyte numbers get worse

I think it'd be a safe bet that it will be withdrawn here next year

 

[jjesusfreak01]

*Brown taps his foot for twenty minutes waiting for the frusemide to work while watching the electrolyte numbers get worse

I think it'd be a safe bet that it will be withdrawn here next year

I have been told they no longer carry Lasix in my area for these reasons.

Also, we don't carry BIPAP machines, I have been told, due to the size. I guess they are probably getting small enough now, but at $2000 a pop, that's a lot for a 30 ambulance system. A BIPAP can replace the CPAP on the truck, right? I assume they can work in a CPAP like mode.