Asses Patient, record vital signs

1
Mask CPAP for EMT-Basic
Asses Patient, record vital signs and pulse ox
before applying oxygen

• CPAP Inclusion Criteria
• (2 or more of the following)
• Retractions or Accessory muscle use
• Respiratory Rate gt 25 / minutes
• Pulse Ox lt 94 at any time
• CPAP Exclusion Criteria
• -Unable to follow commands
• Apnea
• Vomiting or active GI bleed
• Major trauma / pneumothorax
• Conditions Indicated for CPAP
• Congestive Heart Failure
• COPD / Asthma
• Pneumonia

Does the Patient meet two or more Inclusion
Criteria?
No
Yes
Yes
Does the Patient meet any Exclusion Criteria?
Continue standard BLS Respiratory Distress
Protocol
No
Administer CPAP 5 cm H2O of pressure AND
Reassess patient, vital signs, and respiratory
distress scale every 5 min.
Patient condition is deteriorating Decreasing
LOC Decreasing Pulse Ox
Notify Medical Control Consider ALS Intercept and
continue BLS Respiratory Distress Protocol
Patient condition is stable or improving
Continue CPAP Reassess patient every 5 minutes
Notify Medical Control
Complete CPAP Data Form and submit to service
Medical Director for each patient placed on CPAP
Remove CPAP Apply BVM Ventilation
2
Adult Respiratory Distress Protocol (Age greater
than 12)
Routine Medical Assessment
References Kosowsky JM, Stephanides SL, Branson
RD, Sayre MR. Prehospital use of continuous
positive airway pressure (CPAP) for presumed
pulmonary edema a preliminary case series.
Prehosp Emerg Care 2001 Apr-Jun5(2)190-6Kosows
ky JM, Gasaway MD, Stephanides SL, Ottaway M,
Sayre MR. EMS transports for difficulty
breathing is there a potential role for CPAP in
the prehospital setting? Acad Emerg Med 2000
Oct7(10)1165 Reissmann HK, Ranieri VM,
Goldberg P, Gottfried SB. Continuous positive
airway pressure facilitates spontaneous breathing
in weaning chronic obstructive pulmonary disease
patients by improving breathing pattern and gas
exchange. Intensive Care Med 2000
Dec26(12)1764-72
Oxygen Administer High Flow O2 via NRM Titrate to
maintain Pulse ox of gt92

• Is Patient a candidate for Mask CPAP?
• Respiratory Rate gt 25 / min
• Retractions or accessory muscle use
• Pulse ox lt 94 at any time

Yes
See Mask CPAP Protocol
No
Is the Patient wheezing and/or does the Patient
have a history of Asthma/COPD?
Yes
Administer Albuterol / Atrovent by Nebulizer
No
Does the Patient have rales and/or does the
Patient have a history of congestive
heart Failure (CHF)?
If Basic IV Tech Administer 1 sublingual
spray/tablet NTG every 5 minutes as long as
systolic BP is greater than 100mmHg
Yes
No
Contact Medical Control Consider ALS Intercept
and Transport