CPAP and BiPAP

  1. Management of Adequate and Inadequate Respiration
    1. Respiratory Compromise
      1. Assure an adequate airway
      2. Review supplemental oxygen therapy
      3. Continuous Positive Airway Pressure (CPAP)/Bi-Level Positive Airway Pressure (BiPAP)
        1. Definitions/Purpose
          1. CPAP – a device to provide continuous positive airway pressure in the spontaneously breathing patient
          2. BiPAP – a device to provide differential positive airway pressure in the spontaneously breathing patient.
            1. higher positive pressure during inspiration (e.g., 10 cm water pressure)
            2. lower positive pressure during expiration (e.g., 5 cm water pressure)
            3. Augments patient’s spontaneous breathing with positive pressure ventilation during inspiration
          3. increase lung compliance
          4. reduce alveolar collapse
          5. increase laminar airflow
          6. decrease intubation rates
        2. Indications
          1. CHF/Acute pulmonary edema
          2. COPD/Asthma
  2. Near-drowning
  3. Similar equipment may be used for home treatment of sleep apnea
  4. Contraindications
    1. inability to tolerate the mask
  5. Complications
    1. requires adequate tidal volume
    2. the patient must be alert and follow instructions
    3. the patient must tolerate the mask
    4. gastric insufflation
    5. vomiting and aspiration risk
    6. barotrauma
    7. facial hair
    8. dysmorphic faces
  6. Procedure
  7. Assisted positive pressure ventilation
    1. Purpose/definition
    2. Indications
    3. Contraindications
    4. Complications
    5. Procedure
  8. Assisting patient ventilations
    1. Review of techniques used by EMRs, EMTs, and AEMTs
      1. Purpose
      2. Indications
      3. Contraindications
      4. Complications
      5. Procedures
    2. Review of the physiologic differences between normal and positive pressure ventilation
    3. BiPAP/CPAP
      1. Purpose
      2. Indications
      3. Contraindications
      4. Complications
      5. Procedure
    4. Positive End Expiratory Pressure (PEEP)
      1. Purpose
        1. provide positive airway pressure to prevent alveolar collapse at the end of expiration
        2. refers to positive pressure situations
        3. to increase lung compliance
      2. Indications
        1. hemodynamically stable patient receiving positive pressure ventilation
          1. COPD
          2. CHF
          3. drowning
        2. Patient transfer
      3. Contraindications
      4. Complications
        1. can diminish the venous return
        2. can cause barotrauma
      5. Procedure
        1. Venous return (preload)
          1. skeletal muscle pump
          2. thoracoabdominal pump
          3. respiratory cycle
          4. gravity
          5. effects of IPPB, PEEP, CPAP, and BiPAP on venous return

Scenarios:

  • Case Study: CPAP use in an asthmatic patient
  • Case Study: BiPAP use in pulmonary edema patient

Content Creator: Charles Bishop
CAPCE Course Number: 21-EMTP-F3-3207
Total CE Hours: 1.0
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.