CPAP should be considered when the paramedic suspects a working diagnosis of Pulmonary Edema or COPD exacerbation. These are often identified by adventitious lung sounds (ie crackles and/or wheezes respectively). Further, CPAP should be considered as an additive therapy rather than the main tool to assist with dyspnea.
In the context of pneumonia, the patient care goals are different; it is not recommended to routinely use CPAP for pneumonia.
The care goals associated with management of pneumonia in pre-hospital/out-of-hospital settings are oxygenation, early transport (time to antibiotic administration), and possible fluid administration for dehydration or sepsis.
Disease process and exacerbation can be difficult to distinguish in pre-hospital/out-of-hospital settings. If the patient still experiences dyspnea even after oxygenation targets (BLS PCS Oxygen Therapy Standard) are reached and you believe the etiology may be COPD exacerbation, we recommend a consult with a Base Hospital Physician to establish a treatment plan that is safe and tailored for your patient.
Further information on pneumonia, pulmonary edema and CPAP:
Pneumonia is an infectious pathology while pulmonary edema is not usually caused by an infection. It is a marker for a more severe underlying systemic pathology like heart failure or volume overload.
Pneumonia can cause pulmonary edema as the inflammatory state in pneumonia can cause leakage of fluid from the blood vessels and capillaries thus causing massive collection of fluid in the lungs that give an appearance like that of pulmonary edema. When the patient reaches this point, it is very unlikely that the parameters for safe use of CPAP will be met.
Further information on pneumonia, COPD and CPAP:
CPAP does not treat pneumonia directly, however it can reduce the work-of-breathing often seen with other underlying respiratory diseases such as COPD.
More information on compliance, resistance, CPAP and COPD can be found on MedicLEARN: https://mediclearn.rppeo.ca/course/view.php?id=225
As management of pediatric bradycardia with a pulse is not currently in the ALS PCS, we recommend to consult with a Base Hospital Physician to discuss a management plan using the AHA Guidelines in your recommendations.
You can find the latest 2020 AHA Guidelines on the following website: https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
Here are the highlights of the 2020 AHA Guideline for Pediatric Bradycardia with a Pulse:
If patient is bradycardic and presenting with cardiopulmonary compromise
Start with airway management, oxygenation and ventilation
If HR 60 despite oxygenation/ventilation
If Bradycardia persists
Continue CPR and monitor pulse q 2 min
Obtain vascular access (IV/IO) or ETT if IV/IO unavailable
Consider EPI IV/IO/ETT
IV/IO: EPI 0.1mg/ml concentration: 0.01mg/kg
ETT: EPI 1mg/mL concentration: 0.1mg/kg
Consider Atropine IV/IO for increased vagal tone or primary AV block
minimum single dose: 0.1mg
maximum single dose: 0.5mg
Consider transcutaneous pacing
Identify and manage other possible underlying causes such as:
Medications / overdoses
Why is the pain management protocol for cardiac ischemia written in a way to limit pain medication use until the patient reports a 7/10 or greater, especially given that while a patients "pain is what they say it is", as a numeric scale it is still subjective to the patients experience. This encourages providers to lead the patient to a specific end. Thank you.
What is the difference between home CPAP for sleep apnea and CPAP we carry/our medical directive? Why can people with sleep apnea can use CPAP while sleeping (not sitting upright) and our medical directive doesn't allow (contraindication if patient cannot sleep upright)?
In the event of a rosc and I'm running a dopamine infusion where my patient re arrests, should I still discontinue dopamine over 5-10 minutes at this time or immediately?
For the COVID considerations it says to consider IM epinephrine as per the bronchoconstriction medical directive to a maximum of 2 doses. What would the dosing interval be?
Can a Paramedic administer Gravol to a patient even if there is previous self-administration, but the symptoms are still present? Is it considered an overdose?
Should we withhold narcotics to treat a pregnant patient for pain management?
Tachydysrhythmia- conversation with ACP's regarding Adnenosine. Case in point, ACP treated patient with 6mg IVP, no change in rhythm but the BP dropped to 96 systolic. This patient fell into the zone of no more adensone and was not hypotensive (less than 90) for PATCH cardioversion. Minutes later patient normal tensive...can you treat again with adenosine or is it the same as once your out your out?
Is it an RPPEO expectation that we must always attach a cardiac monitor before administering any medication?
Just recently did an inferior MI pt with ST elevation in II, III and avf with reciprocal changes to V3 to V6. We did a 15 lead by putting v4 on the right side and it was negative. His pressure was systolic 160 . I gave the pt so e ASA but was confused if Nitro should of been given therefore I didn't give any. We were both PCP . Should Nitro be given if the 15 lead is negative? And follow the STEMI protocol?
When it is determined the patient is experiencing cardiac ischemia and also presenting with acute pulmonary edema (IV established, BP over 140) should the treatment plan only include 0.4mg doses of nitro x6 and try CPAP? Or can nitro be administered to the 0.8mg as stated in the edema directive? My opinion would be to only treat with 0.4mg nitro.