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Acute Pulmonary Edema/CHF  1. Initiate O2 via Mask or Cannula according to distress

Acute Pulmonary Edema/CHF  1. Initiate O2 via Mask or Cannula according to distress 2. ALS Crews initiate CPAP 15-25 L/min (5-10 cm H2O) according to distress. 3. Initiate IV with saline lock or NS at KVO rate. 4. Monitor EKG and Vital signs.

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Acute Pulmonary Edema/CHF  1. Initiate O2 via Mask or Cannula according to distress

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  1. Acute Pulmonary Edema/CHF •  1. Initiate O2 via Mask or Cannula according to distress • 2. ALS Crews initiate CPAP 15-25 L/min (5-10 cm H2O) according to distress. • 3. Initiate IV with saline lock or NS at KVO rate. • 4. Monitor EKG and Vital signs. • 5. Administer Lasix 40-100 mg IV • 6. If B/P >100 systolic administer NTG 0.4 mg SL up to 3 doses • 7. Consider Albuterol up to 5 mg Neb. if bronchospasm/ wheezing is present. • 8. Contact Medical Control for Morphine 2-10 mg IV • Pediatric Doses • Lasix 1.0 mg/ kg IV • Albuterol up to 5 mg via nebulizer • NTG is not used. • _______________________ _________________ • Peter Hyman, MD Date

  2. Acute Respiratory Distress (COPD, Asthma) 1. Initiate O2 via Mask or Cannula according to distress 2. ALS Crews initiate CPAP 15-25 L/min (5-10 cm H2O) according to distress. 3. Administer Albuterol up to 5.0 mg via nebulizer at 8-10 L/ minute. 4. Monitor EKG and Vital signs. 5. Initiate IV with saline lock or NS at KVO rate. 6. Contact Medical Control Pediatric Doses (ages 2-12) Albuterol up to 5.0 mg via Nebulizer at 8-10 l/min.

  3. Boussignac CPAP System • Select the appropriate size face mask for your patient: - Child Mask (Size 3) - Small Adult Mask (Size 4) - Medium Adult Mask (Size 5) - Large Adult Mask (Size 6)

  4. Boussignac CPAP System • Set Oxygen flow to deliver CPAP in cmH2O of water pressure: - 15 liters = 5cmH2O - 20 liters = 7.5 cmH2O - 25 liters = 10 cmH2O

  5. Boussignac CPAP System • Connect funnel end of Green Oxygen Tubing to an O2 source capable of delivering flow up to 25 liters/min. • This provides the full range of CPAP needed for clinical use (5-10cmH2O). • Typically a “D” size cylinder in the field.

  6. Boussignac CPAP System • Insert white end of the Boussignac CPAP into the face mask.

  7. Boussignac CPAP System • If required, insert a pressure manometer between the Boussignac CPAP and the face mask.

  8. Boussignac CPAP System • Explain to the patient how the Boussignac CPAP will help their breathing. • Gently hold the mask to the patients face insuring a good face/mask seal. • Turn the flow control device to the desired liters/min, generally 15 l/min, to begin the CPAP. • Gradually adjust the flow to achieve the desired level of CPAP.

  9. Boussignac CPAP System • Secure the Boussignac CPAP System to the patient with the head strap. • Check around the mask for any leaks. • Adjust the mask and/or head strap accordingly.

  10. Boussignac CPAP System • If the patient requires suctioning of the oral cavity, insert French size suction catheter through the open end of the Boussignac CPAP System. • CPAP pressure will not be affected.

  11. Boussignac CPAP System • CO2 can be monitored with either a nasal cannula or an in-line CO2 adapter.

  12. Boussignac CPAP System • When transporting the patient in the ambulance, connect the Green Oxygen delivery tube to the wall Oxygen in the vehicle.

  13. Boussignac CPAP System + Nebulizer • Fill the nebulizer with the prescribed medication.

  14. Boussignac CPAP System + Nebulizer • Insert the 22 mm male end of the nebulizer into the face mask. • Insert the 22 male end (white) of Boussignac CPAP into the nebulizer.

  15. Boussignac CPAP System + Nebulizer • Connect the funnel end of the nebulizer’s gas delivery tube to a gas source. • Turn on gas source to 6 liters/min. to power the nebulizer. • Maintain O2 flow to Boussignac CPAP System at 15 l/min. (5cmH2O).

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