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CPAP

CPAP. Pre-Hospital Treatment Using the Respironics Whisperflow . CPAP-What is it?. CPAP is an acronym for: C ontinuous P ositive A irway P ressure. Anatomy Review. Anatomy Review. Alveoli. Chest Wall. Normal Respiration. Physiology Review.

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CPAP

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  1. CPAP Pre-Hospital Treatment Using the Respironics Whisperflow

  2. CPAP-What is it? • CPAP is an acronym for: • Continuous • Positive • Airway • Pressure

  3. Anatomy Review

  4. Anatomy Review

  5. Alveoli

  6. Chest Wall

  7. Normal Respiration

  8. Physiology Review • Ventilation- The mechanical exchange of air between the lungs and the atmosphere. • Pulmonary ventilation refers to the total exchange of gas. • Alveolar ventilation refers only to the effective ventilation within the alveoli.

  9. Physiology Review • Respiration- the exchange of oxygen and carbon dioxide between the atmosphere and the body cells • -Occurs at the alveolar level

  10. Diffusion • Diffusion – the movement of gas from an area of higher concentration to an area of lower concentration. • This is how respiration occurs

  11. Diffusion • In order for respiration to take place and be efficient you must have: • Functional alveoli and capillary walls • An interstitial space between the alveoli and the capillary wall that is not enlarged or filled with fluid

  12. Pulmonary Perfusion • Pulmonary perfusion- the process of circulating blood through the pulmonary capillary bed, in order for this to occur you must have: • A properly functioning heart (Pump) • Proper vascular size (Tank) • Adequate blood volume / hemoglobin (fluid)

  13. What do we use CPAP for? • Asthma • COPD • CHF/Pulmonary Edema

  14. Asthma • A chronic inflammation disorder in the airways • Acute episodes “triggered” by something • This releases histamine and leukotrienes causing • Bronchial smooth muscle constriction • Bronchial plugging from mucous secretion • Inflammation changes

  15. Asthma • Leads to increased resistance to airflow • Leading to hypoxemia and CO2 retention which leads to hyperventilation and respiratory fatigue

  16. Asthma Pt. Presentation • Tripod position • Wheezing • A silent chest is an ominous sound! • Flow rates are to low to generate breath sounds • Inability to speak • Pulse > 130 • Respirations > 30

  17. Asthma- Differential Diagnosis • Consider other causes for wheezing • Pneumonia • COPD • Foreign body aspiration • Heart failure • Pneumothorax • Pulmonary embolism • Toxic inhalation

  18. COPD • Chronic Obstructive Pulmonary Disease • Chronic Bronchitis • Emphysema

  19. Bronchitis • Inflammation of the bronchioles with large amounts of sputum present • Mucous obstructions • Leads to gas trapping • Leads to hyper inflation • Leads to permanent damage • Short of breath due to mucous in alveoli

  20. Bronchitis Pt. Presentation • History of respiratory infection • Productive cough • Large quantity of sputum • Short of Breath • Cyanosis

  21. Bronchitis Pt. Presentation Mucous Air comes in , but can’t get out

  22. Bronchitis “Blue Bloater” • A productive cough 3 months of the year for 2 consecutive years

  23. Emphysema • Chronic disease • Results in destruction and loss of elasticity of the alveolar walls • Caused by: • Cigarette smoking • Exposure to unfriendly environment (ie: asbestos)

  24. Emphysema Pt. Presentation • Skinny • Short of breath all the time • Shortness of breath worsens with any activity • Barrel chest • Long expiratory phase- pursed lips • Pink in color (polycythemia)

  25. Emphysema- “Pink Puffer”

  26. Congestive Heart Failure (CHF) • Left ventricle unable to empty • Leads to increased pressure in left atria • Causes increased pulmonary pressures which leads to fluid collecting in the lungs

  27. CHF Pt. Prsentation • Respiratory distress • Orthopnea • Must sit or stand to breath comfortably • Spasmodic coughing (pink frothy sputum) • Paroxysmal Nocturnal Dyspnea • Apprehension (smothering feeling) • Cyanosis • Diaphoresis • Rales, possible wheezing • JVD

  28. CHF Pt. Presentation • Vitals • Increased B/P early (180’s/90’s) • Decreased B/P later as patient tires • Tachycardia • Increased respiratory rate early (high 30’s) • Decreased respiratory rate as patient tires

  29. Respironics Whisperflow CPAP

  30. Whisperflow Kit Contents • Mask and head strap • Air filter • Hose • PEEP valves are separate

  31. PEEP • Positive • End • Expiratory • Pressure

  32. How PEEP is Measured • PEEP is measured in cm of water • We use two different PEEP valves • 7.5 (yellow) for COPD and asthma • 10 (green) for CHF/Pulmonary Edema • If a pt. has a Hx. of COPD the 7.5 is used even if treating the pt. for CHF.

  33. 7.5 PEEP • Used for COPD and Asthma • The lower pressure prevents alveolar damage to COPD pts. due to the loss of elasticity in the alveoli • If the 10 peep was used it could cause destruction of alveoli which would be detrimental to the pt.

  34. 10 PEEP • Used for the treatment of CHF with pulmonary edema with no hx. of COPD • The higher pressure allows the fluid in the lungs to be returned to the circulatory system

  35. How it works-Mechanically • Causes Venturi effect-Can generate large flows (140 L/min) with relatively little oxygen use. • Mixes large quantities of ambient air with a little supplemental oxygen • FiO2 ~30%

  36. Oxygen Consumption

  37. Physiology of PEEP • It changes the partial pressure of oxygen in the blood • Deoxygenated blood has a lower partial pressure of oxygen than alveolar air so oxygen transfers from the air into the blood.

  38. Physiology of PEEP (cont.) • 7.5 cm/H2O CPAP increases the partial pressure of alveolar air by approximately 1% • This increase in partial pressure ‘forces’ more oxygen into the blood • Even this small change in partial pressure is enough to make a clinical difference

  39. Goals of CPAP • Change the pressure gradient to force more oxygen into the blood • Maintain positive pressure in the lungs to force fluid out. • Prevents complete collapse of alveoli during exhalation allowing greater surface area for improved gas exchange.

  40. Indications • Hypoxemia with signs and symptoms of COPD, CHF(pulmonary edema), or Asthma • Pt. must be breathing and able to protect their airway.

  41. Contraindications • Penetrating Chest Trauma • Severe Hypotension • Persistent Nausea and/or Vomiting • Obtundation • Respiratory or Cardiac Arrest • Inability to Protect their own Airway

  42. Application of CPAP • Hands on demonstration of the application of CPAP to follow at a later date.

  43. References • Information for this PowerPoint presentation was obtained from: • LEMS Clinical Care Guidelines • Charlottesville Albemarle Rescue Squad

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