1	CPAP Continuous Positive Airway Pressure Presented by Ben Usatch, MD
2	Prehospital CHF Management New Thinking Oxygen Nitrates Diuretics CPAP / Non-Invasive Ventilation Old Thinking Oxygen Diuretics Nitrates Morphine Intubation
3	Normal Respiration
4	Fluid in the Chest
5	Shunt What we can do: Supplemental O2 to the functioning alveoli CPAP / Non-invasive ventilation Force fluid out Pop open alveoli Occurs when blood passes through the lungs w/o undergoing CO2 and O2 exchange Associated w/ decreased PO2 Collapsed alveoli Fluid in alveoli
6	Basic Noninvasive Ventilation Manual with assisted ventilations w/BVM Within scope of BLS practice Immediate feedback Simple and fast Ideal for very short ETAs
7	Indications for CPAP Moderate/Severe Respiratory Distress Congestive Heart Failure Pulmonary Edema Wet lung sounds COPD??? Asthma??? Pneumonia???
8	CPAP: How It Works Improves gas exchange Improves hemodynamics by reducing preload and afterload. Increases intra-airway pressure Prevents alveoli collapse (atelectasis)
9	CPAP: How It Works The generator Valves
10	Precautions Unable to understand directions Excessive secretions Decreased respiratory effort Patients with history of COPD and asthma prone to develop pneumonthorax
11	Procedure Explain procedure to the patient Ensure you have adequate O2 on-hand Place mask over face and secure w/ strap “Flow” fully open” “O2” fully closed
12	Procedure (contd) Monitor O2 saturation Monitor patients respiratory status If patient worsens, default to BVM & consider intubation Provide emotional support
13	Procedure (contd) Provide supplemental medications Nitoglycerine, Lasix, and Morphine Inform ED of pending arrival and the need for CPAP
14	Signs of Success Increasing SPO2 Decreased work of breathing
15	Signs of failure Increased mask clicking Decreased mask clicking Worsening SPO2
16	Contraindications Respiratory Arrest Decreased LOC Possible Pneumothorax Unconscious Facial Trauma
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