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26.1 CPAP / BiPAP

All Providers

  • Indications
    • Respiratory Distress not improved with other measures including
      • Acute pulmonary edema
      • Asthma
      • COPD
      • Pneumonia
      • Respiratory failure
  • Contraindications
    • Pneumothorax
    • Apnea
    • Upper gastrointestinal bleeding
    • Recent gastric or esophageal surgery
    • Tracheostomy or other airway disorders
Key Considerations
  • Perform ETC02 monitoring on all patients with respiratory distress receiving medications

Adult

EMT
  • CPAP at 5 cm H2O (oxygen at 10 lpm)
    • Consider when the patient is awake but needs assistance with oxygenation and ventilation such as in CHF/pulmonary edema or COPD
    • Explain the procedure to the patient
  • Nebulized albuterol may be given concomitantly with CPAP
AEMT
  • BiPAP Initiation if not already RX by practitioner
    • 15 cm H2O IPAP
    • 5 cm H2O EPAP
    • 100% FiO2
  • Persistent hypercapnia
    • increase IPAP by 2 cm H2O increments up to max of 21 cm H2O
  • Persistent hypoxia
    • increase BOTH IPAP/EPAP by 2 cm H2O increments to maximum of 11 cm H2O EPAP
Paramedic
  • Consider midazolam administration to facilitate CPAP/BiPAP in an anxious patient
    • 2.5-5 mg IV/IO/IM/IN
    • may repeat times one in 5 minutes

Pediatric
not to exceed adult dose

EMT
  • Initiate CPAP 5 cm H2O of PEEP
    • Nebulized albuterol may be given concomitantly with CPAP or BiPAP
AEMT
Paramedic
  • Suction may be necessary to clear secretions
  • BiPAP Initiation for >7 kg
    • 10 cm H2O IPAP
    • 5 cm H2O EPAP
      • 100% FiO2