Yay for life saving

[Sassafras]

First time I felt like I made a difference or was there to witness it in any case since it was an ALS call. Got there patient on continuous O2 and he has his condenser cranked to 5 (the highest level on it). Tripoding pursing lips, using entire body to try and breathe. Classic barrel chesting. Pulse ox a whopping 68%. Pulse 108. Dude got a NR at the full 15 liters. Usher to litter and ALS arrived as we were securing to litter. Saturation up to 97% but still diaphoretic and working hard to breathe. Medic student takes two passes to start a line after giving a breathing treatment then they determine it's not working. Pt says he's getting tired they switch to CPAP. Finally he started to calm. Still labored at hospital but not sweating and BP 149/98 as opposed to 180/108 when we started. It was cool to watch the body work to stay alive and watch the medics work their magic. Pt is still very sick but we were able to make a difference and it feels pretty good.

 

[Hockey]

CHF'er?

Good job though

 

[Sassafras]

CHF'er?

Good job though

No Hx of CHF. Lungs tight but not wet and no edema. CPAP may have made it worse if it was CHF so I'm leaning toward no. LOL

 

[Aidey]

What makes you say CPAP may have made it worse if it was CHF?

 

[Shishkabob]

Erm... CPAP making CHF worse?

 

[the_negro_puppy]

So what was the cause of his resp distress? Emphysema? Chronic Bronchitis, asthma?

 

[Amycus]

CPAP is great for CHF. We're trained to do it if someone is presenting with CHF signs using our BVMs.

 

[MrBrown]

CPAP is great for CHF. We're trained to do it if someone is presenting with CHF signs using our BVMs.

Are you confusing PEEP and CPAP? PEEP valves go onto a bag mask for patients who need assisted ventilations whereas Brown has never heard of CPAP on a bag mask

 

[Amycus]

MrBrown- I may be mixing up my terminology. Our ALS rigs carry CPAP equipment, our BLS units do not. We were instructed if someone is having an episode of CHF with accompanying signs/symptoms, to use a BVM to create a seal, and use small, controlled positive pressure ventilations, ideally matching their respiratory rate, never letting the bag fully inflate. If possible, gradually lowering the ventilation rate we are providing over time. The intended purpose being to help mimic the effects of CPAP without actually having CPAP equipment, until the PT can get definitive care. I could be mistaking parts of my training, as to be honest I've never actually had to do this, but the medics spoke very highly of it working in the field for them prior to CPAP gear.

 

[usafmedic45]

Are you confusing PEEP and CPAP? PEEP valves go onto a bag mask for patients who need assisted ventilations whereas Brown has never heard of CPAP on a bag mask

PEEP and CPAP are, at least from a physiological standpoint, the same thing. They are both simply an elevation of the baseline pressure that exist as the end of expiration (hence the "EE" in PEEP). The difference is it is CPAP if the patient is not getting any mechanically ventilated breaths (i.e., they are breathing entirely on their own). It's PEEP if they are being mechanically ventilated, hence why the valve that goes on the BVM is a PEEP valve. You're right, you can't deliver CPAP with a BVM because of the nature and mechanics of a BVM.

We were instructed if someone is having an episode of CHF with accompanying signs/symptoms, to use a BVM to create a seal, and use small, controlled positive pressure ventilations, ideally matching their respiratory rate, never letting the bag fully inflate. If possible, gradually lowering the ventilation rate we are providing over time. The intended purpose being to help mimic the effects of CPAP without actually having CPAP equipment, until the PT can get definitive care. I could be mistaking parts of my training, as to be honest I've never actually had to do this, but the medics spoke very highly of it working in the field for them prior to CPAP gear.

No offense but what brain dead moron taught you that? If you are creating a tight seal with a BVM and not giving full breaths, you're not giving CPAP. You're asphyxiating the patient incrementally especially as you lower the ventilation rate you are giving. The patient with a BVM held to their face cann't draw in any more air than you are giving him with the ventilations unlike with a true CPAP circuit where they can have as large of a minute ventilation as they need. Also, you're basically making them rebreath their CO2 which could worsen their condition.

If you don't believe me and really feel the need to test this, have your partner hold the BVM over your mouth and employ that technique. BTW, I'm not legally responsible if you get hurting doing something that stupid (in other words, don't try this at home).

 

[LuvGlock]

Nice job on the save!

 

[Sassafras]

O.k. had nice long reply typed up with my thumbs on my phone and deleted it all by mistake and then was too tired to try again so I went to sleep and said to myself "self, respond from the computer tomorrow".

O.k. backing up, I think I may have confused the comments from Mr. Medic about CPAP, because I think he actually said "they used to recomend NO cpap for COPD, but now they are finding it actually helps in accute situations like this" so just forget that little schpeal.

Regardless, nothing, other than resp distress indicated he had CHF. No history, no swelling anywhere, no wet lungs. Medics felt that wasn't the case either.

As to what made him crap out? I don't know. He said he'd been experiencing increased shortness of breath for 2 days and was finally not able to control it on his own medication. We arrived and put him on the NR and cranked the O2 up.

Some possible scenerios the Medics discussed were maybe pneumonia, but they could not get a temp on him because our thermometers would not work on our rig (we are looking into why they aren't working since they were working last time they were checked), the breathing treatments weren't working just making him more sweaty and tachy, so they called med control that suggested another round of breathing treatments with mag (something. not sure what mag drug it was). They kept tossing around a possible cardiac issue but 12 lead looked normal. We really aren't sure WHAT caused it, honestly, and barring him contacting EMS again (which may happen as I'm told he's been transported by us before) we won't find out. We are not affiliated with the hospital and have no jurisdiction to request final diagnoses.

We don't have ALS units with our local units. It is volly BLS and if you need a medic you call county and have the paid medics dispatched. They arrived as we were loading the pt on the litter and took over from there. They travel with us, and all we do is monitor vitals and assist if they ask for assistance (oh we transport too as their rigs stay with their EMT's who come back later to pick them up if we don't drop them off at their station on the way back). I do my trip sheet w/o meds and their interventions. They do their trip sheet however they do it. Apparently no one has ever had a volly emt take notes for them and since they were busy the entire transport trying to keep him from bottoming out they never wrote anything down, so although I didn't know the actual medication's full name, I did document a time for med control contact and they were grateful I had documented what I did so they could go back and make sure they didn't forget to document things on their paperwork.

I'd say I didn't do the save, but got to witness paramedicine as it saved a life. I gave some oxygen which sustained him long enough to get him real help. Then I sat back and watched them work their magic. It was fascinating to watch to say the least.