FLOW SAFE CPAP MCHENRY WESTERN LAKE COUNTY EMS
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1 FLOW SAFE CPAP MCHENRY WESTERN LAKE COUNTY EMS
2 CPAP Device: Why change? OLD: Oxy-PEEP Does not allow Meds via nebulizer PEEP measurement Shortages/recalls Packaged in lg box Headstrap may be uncomfortable & challenging to use 3 settings New: Flow-Safe Easier to repeat NTG Nebulizer can be used Actual PEEP measured Leaks detected Smaller package Comfortable headstrap 1 setting
3 Just a reminder how it works CPAP works by splinting the lungs with a constant pressure of air This reduces work of breathing In CHF, forces excess fluid out of alveoli & interstitial space back into the vasculature Also decreases venous return to the heart thereby lessening its workload Bottom line: Takes patients close to needing intubation & rapidly reverses their condition avoiding complications & death
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6 CPAP No Change SOP Indications Contraindications Change Device Procedural steps
7 CPAP Indications Heart Failure - acute Asthma/COPD - severe Drowning - near Flail chest (w/o pneumothorax) Contraindications Airway Unable to obtain adequate seal Facial anomalies/injury Breathing Inadequate resp rate/effort Pneumothorax Penetrating chest trauma Circulation SBP <90 mmhg / DBP <60 Disability - Consciousness Decreased LOC Unable to follow commands GI Aspiration risk Gastric distention Vomiting Pregnant
8 THIS IS HOW CPAP FEELS TO THE PATIENT!!
9 FLOW SAFE CPAP 02 Tubing CPAP Valve Pop off Valve Forehead adjustment Head adjustment straps PEEP Manometer Quick Release Clip
10 OXYGEN FLOW RATE = PEEP 15 L = approx 3-4 cm H2O PEEP 20 L = approx 6-7 cm H2O PEEP 25 L = approx cm H2O PEEP
11 TITRATE PEEP TO PATIENT S WORK OF BREATHING OLD PROCEDURE PEEP started at 10cm H2O Not titrated to work of breathing NEW PROCEDURE START AT 15 L WHICH EQUALS 3-4 cm H2O PEEP Titrate up to patient response (decreased work of breathing) Maximum PEEP 25 L or cm H2O PEEP
12 Flow-Safe CPAP --- PEEP Pressure manometer between CPAP valve & face mask measures actual PEEP being delivered Leak in system (e.g., lack of tight face-mask seal) will affect PEEP
13 What is the PEEP?
14 What is the PEEP?
15 Assess PEEP as patient exhales
16 EXPLAIN PROCEDURE TO PATIENT MAY REQUIRE EXTENSIVE COACHING If they are anxious, a little Versed may help. See appropriate SOP
17 OPEN PACKAGE SECURELY CONNECT MASK TO VALVE/TUBING
18 OPEN PACKAGE Yellow label displays PEEP settings
19 02 Flow Attach CPAP O2 tubing to regulator/flow-meter Begin O2 15 L If needed, slowly increase O2 to desired O2 sat/peep (do not exceed 30 LPM)
20 UNDO 1 OR 2 OF THE QUICK RELEASE CLIP(S)
21 Hold, or have pt. hold mask snuggly to face Good face-mask seal is critical
22 Tighten head straps using Velcro tabs
23 Adjust forehead pad flat on forehead
24 Adjust forehead pad flat on forehead WRONG RIGHT Squeeze together and raise or lower to adjust Adjusted
25 USE QUICK RELEASE TO ADMINISTER NITRO PER SOP SOP: If systolic is 90 or above, give nitro every 5 minutes unlimited
26 IF YOU RECEIVE PERMISSION TO USE CPAP WITH SEVERE ASTHMA/COPD & PATIENT IS WHEEZING The patient will need a neb treatment CONNECT NEBULIZER BETWEEN CPAP VALVE & MASK
27 Capnography can be used under CPAP CPAP with MWLCEMS Neb
28 Adaptors Some nebulizers may require an adaptor (same adapter used for in-line- nebs) You will need this for Good Shepherd nebulizers 22 ml adaptor
29 Flow-Safe CPAP Device PEEP depends on 1. O2 flow rate 2. Face mask seal (leak) Oxygen concentration depends on 1. O2 flow rate 2. Respiratory rate 3. Tidal volume
30 How long tanks will last at different flow rates
31 CPAP Device Transition Attrition (use your old one, replace with a new one) Devices already on vehicles will not immediately be replaced Transition will occur w/ replacement devices When an old device used, it will be replaced w/ new device (as hospital stock allows) New devices available after
32 Documentation Document the oxygen flow rate Document the PEEP reading on the manometer This can be done in your narrative Remember to use the manometer reading when patient exhales.
33 Thanks! THANKS TO THE NWC EMS SYSTEM AND KATHY KNOP FOR SOME OF THE CONTENT OF THIS PRESENTATION
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