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CPAP

Superior EMS

Jan 24, 2019

The Respiratory System

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The Airway

Mechanics of Breathing Four steps

Ventilation of the lungsDiffusion of oxygen from the alveoli into the capillary bloodPerfusion of systemic capillaries with oxygenated bloodDiffusion of oxygen from systemic capillaries into the cells

Diffusion of CO2 occurs in reverse order

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COPD

Chronic Bronchitis

� Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years

� Inspired irritants increase mucus production and the size and number of mucous glands

� The mucus is thicker than normal

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Emphysema

� Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis

� Loss of elastic recoil

� Centriacinar emphysema

� Panacinar emphysema

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Pulmonary Edema

Heart Failure

� General term used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues with blood-borne nutrients

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Congestive Heart Failure

� Systolic heart failure

� Inability of the heart to generate adequate cardiac output to perfuse tissues

� Diastolic heart failure

� Pulmonary congestion despite normal stroke volume and cardiac output

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� Right heart failure� Most commonly caused by a diffuse hypoxic

pulmonary disease� Can result from an increase in left ventricular

filling pressure that is reflected back into the pulmonary circulation

� High-output failure� Inability of the heart to supply the body with

blood-borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility

LOOK

LISTEN

FEEL

Respiratory Assessment

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LOOK: • ANXIOUS OR COMATOSE• ABSENT, MINIMAL OR UNEVEN CHEST RISE• CYANOSIS• ABDOMINAL BREATHING• BREATHING RATE TOO RAPID OR TOO SLOW• RETRACTIONS• NASAL FLARING

Signs of Respiratory Failure

LISTEN:• GURGLING, STRIDOR, CROWING, SNORING• WHEEZING• SPEAKS IN SHORT SENTENCES• MAY BE UNABLE TO SPEAK

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FEEL:

DIAPHORETIC

DIMINISHED OR ABSENT AIR MOVEMENT

CPAP

� Provides:

� “Continuous positive pressure throughout the respiratory cycle [which] improves oxygenation and tidal volume”

� Thus decreasing respiratory effort

� Thus easing the required workload of the respiratory muscles

� Assists pulmonary compliance

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How it works

� Positive end-expiratory pressure (PEEP) maintains airway pressure above atmospheric at the end of expiration, and continuous positive airway pressure improves oxygenation by increasing functional residual capacity, and can increase lung compliance and decrease the work of breathing.

� So, in other words, it keeps the bronchioles and alveoli open, helps force excess fluid to leave the interstitial tissue surrounding the alveoli which allows for better exchanges of gases. The bronchioles also increase in diameter, promoting better airflow down to the alveoli.

Indications

� Patient is awake and able to follow commands and who is in severe respiratory distress as evidenced by two of three of the following protocol.

� A respiratory rate >24 breaths per minute AND/OR

� Sp02 <90% at any time AND/OR � Accessory muscle use

� And with signs and symptoms consistent with: Exacerbation of chronic obstructive pulmonary disease (COPD), OR Acute pulmonary edema , or CHF

� CONDITIONS:• Age>12and>40kg

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Contraindications

� Asthma exacerbation � Unable to cooperate � Suspected Pneumothorax � The patient is intubated � The patient cannot maintain their airway or there is a threat to the airway (e.g. foreign body airway

occlusion, ongoing vomiting or GI Bleeding). � Decreased mentation (unresponsive to speech, and/or unable to follow commands). � Respiratory rate <8/min � Systolic BP <90 mmHg � Cardiac arrest � Major trauma or burns (face, neck, chest/abdomen) � Facial anomalies � Inability to sit upright � Tracheostomy

Application

� Explain procedure to patient

� Apply mask to patients face and make a good seal

� Hook up tubing to oxygen source

� Apply oxygen at 10LPM (No more No Less)

� Adjust PEEP as necessary