5-2 CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

Purpose: To rapidly improve vital signs, gas exchange, reduce the work of breathing, decrease the sense of dyspnea, and decrease the need for endotracheal intubation in patients who suffer from shortness of breath from asthma, COPD, pulmonary edema, CHF, and pneumonia. In patients with CHF, CPAP improves hemodynamics by reducing left ventricular preload and afterload.

Appropriate Personnel: EMT Basics, EMT IV Tech, EMT Intermediate and EMT Paramedic

Inclusion Criteria: Any patient who is in respiratory distress with signs and symptoms consistent with asthma, COPD, pulmonary edema, CHF, or pneumonia and who is:

1. Awake and able to follow commands
2. Is over 12 years old and is able to fit the CPAP mask
3. Has the ability to maintain an open airway
4. And exhibits two or more of the following;
   1. a respiratory rate greater than 25 breaths per minute
   2. SPO2 of less than 94% at any time
   3. use of accessory muscles during respirations

Exclusion Criteria:

1. Patient is in respiratory arrest/apneic
2. Patient is suspected of having a pneumothorax or has suffered trauma to the chest
3. Patient has a tracheostomy
4. Patient is actively vomiting or has upper GI bleeding
5. Patient has an altered mental status

Protocol:

1. EXPLAIN THE PROCEDURE TO THE PATIENT
2. Ensure adequate oxygen supply to ventilation device
3. Place the patient on continuous pulse oximetry
4. Place the patient on cardiac monitor (if available) and record rhythm strips with vital signs
5. Place the delivery device over the mouth and nose
6. Secure the mask with provided straps or other provided devices
7. Initiate CPAP use with a 5 cm H2O of PEEP valve
8. Check for air leaks
9. Monitor and document the patient’s respiratory response to treatment
10. Check and document vital signs every 5 minutes.
11. Administer appropriate medication as certified (continuous nebulized Albuterol (Ventolin) for COPD/Asthma and repeated administration of nitroglycerin spray or tablets for CHF)
12. Continue to coach patient to keep mask in place and readjust as needed
13. Contact medical control to advise them of CPAP initiation
14. Consider ALS Intercept
15. If respiratory status deteriorates consider alternative airway management technique.

Removal Procedure:

1. CPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask or experiences respiratory arrest or begins to vomit.
2. Ensure that patient maintains adequate ventilation and if not, consider alternative airway management techniques.

Special Notes:

1. Do not remove CPAP until hospital therapy is ready to be placed on patient.
2. Watch patient for gastric distention, which can result in vomiting.
3. CPAP is considered a comfort care measure and may be appropriate for use in the patient with a valid DNR if patient consents to use.
4. Due to changes in preload and afterload of the heart during CPAP therapy, a complete set of vital signs must be obtained every 5 minutes.