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