Episode #1: The Nebulizer’s Guide to the Galaxy… Part One

The majority of us are not gifted like MacGyver, and yet we find ourselves in the middle of situations where we have to put together a copious amount of equipment that we may or may not have had training on. Learning to put together a nebulizer and run it through a CPAP mask is no different.

Why do we use CPAP in the prehospital setting? This is a gross-oversimplification, but this is typically going to be as a result of COPD/asthma exacerbation or a patient with significant pulmonary edema due to congestive heart failure or pneumonia. The reason that we utilize CPAP differs though.

The Overview

COPD/Asthma

  • Lower PEEP settings; typically around 5.0cmH2O
  • Used to offset muscle fatigue
  • Mechanically open the terminal bronchioles and alveoli

CHF/Pneumonia

  • Higher PEEP settings; typically around 7.5-10.0cmH2O
    • Literature discusses possible use of 15.0cmH2O, but use extreme caution
  • Used to mechanically open alveoli and overcome pulmonary shunting

EtCO2

  • Avoid sidestream EtCO2
    • Not interoperable with our current CPAP circuit
  • Capnocannulas is where it’s at
  • Nasal Capno is not going to affect your seal!

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