- Reactive airway disease patients with suspected inadequate ventilation, adequate mental status and enough respiratory drive to allow CPAP to function.
- For apneic oxygenation where the patient has an adequate respiratory drive and the airway can be manually opened and maintained. This includes CHF, pneumonia, asthma, and COPD.
- Facial features or deformities that prevent an adequate mask seal. Excessive respiratory secretions.
- Ensure adequate oxygen supply to ventilation device.
- Explain the procedure to the patient.
- Consider placement of a nasopharyngeal airway.
- Place the delivery mask over the mouth and nose. Oxygen should be flowing through the device at this point.
- Secure the mask with provided straps starting with the lower straps until minimal air leak occurs.
- For reactive airway disease (i.e., COPD) set the positive end expiratory pressure (PEEP) at 3-5 cm H2O. Use the lowest possible setting to avoid barotrauma.
- For pulmonary edema, near drowning, aspiration and pneumonia set the PEEP at 5-10 cm H20. Use the lowest possible setting to avoid barotrauma.
- For apneic oxygenation set the PEEP at 5 cm H20.
- Evaluate the response of the patient by assessing breath sounds, oxygen saturation, and general appearance.
- Oxygen levels should be titrated to the patient’s response. Many patients respond to lower FiO2 (30%-50%).
- Encourage the patient to allow forced ventilation to occur. Observe closely for signs of complications. The patient must be breathing for optimal use of the CPAP device.
- Document time and response on patient care report (PCR)
- Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the Greenville County EMS system.
- CPAP application can be completed by all levels of EMT; however, the Paramedic must be the primary attendant.