Indications: Severe respiratory distress and signs and symptoms of acute pulmonary edema or COPD.
CPAP: If the patient is ≥ 18 years of age, with a stable and protected airway and presenting tachypneic, normotensive with an SPO2 < 90% and utilizing accessory muscles to breath and able to cooperate utilize CPAP.
The patient must not be suffering from asthma exacerbation or a suspected pneumothorax and they must not have any major burns to the head or torso or a tracheostomy.
Begin with an initial setting of 5cm H2O (or equivalent flow rate of device as per base hospital direction) and titrate every 5 minutes by an additional 2.5cm H2O to a maximum setting of 15cm H2O.
- While one paramedic is setting up the CPAP equipment, the second paramedic should treat the patient’s underlying condition according to the appropriate treatment protocol.
- Position the patient sitting upright.
- Carefully explain the procedure to the patient.
- Ensure adequate oxygen supply to the ventilation device (connect the generator to the oxygen source – tank or wall outlet).
- Assemble CPAP mask, circuit and device.
- Connect the circuit to the oxygen source according to the manufacturer’s directions.
- Monitor patient as per BLS standards (to include oximetry if available).
- Place ETCO2 monitor if available.
- Turn the ON/OFF valve fully on, be sure the gas is flowing, and then apply the delivery device/mask over the mouth and nose with the enclosed straps. Ensure a tight seal of the mask to the patient’s face.
- Progressively increase the pressure from 5 cmH2O to a max of 15 cmH2O depending on the patient’s response to therapy.
- Confirm amount of CPAP delivery by manometer reading if available. Increase in FiO2 may be required to maintain oxygen saturation ≥ 92%. If using an open CPAP system ensure adequate supply of oxygen is available.
- Check vital signs and pulse oximetry frequently (every 5 minutes).
- Once applied, the mask may be removed for a short time to administer appropriate medication as indicated (for example, Nitroglycerin for CHF and nebulized bronchodilator therapy for COPD).
- If respiratory status deteriorates, remove device and consider intermittent positive pressure ventilation via BVM and/or endotracheal intubation.
- CPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask, requires medications (as per procedure) or experiences respiratory arrest or begins to vomit.
- Intermittent positive pressure ventilation with a bag-valve-mask, placement of a supraglottic airway or endotracheal intubation should be considered as indicated if the patient is removed from CPAP therapy due to deterioration.