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Pre-Hospital Treatment Using the Respironics Whisperflow.

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Presentation on theme: "Pre-Hospital Treatment Using the Respironics Whisperflow."— Presentation transcript:

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2 Pre-Hospital Treatment Using the Respironics Whisperflow

3  CPAP is an acronym for:  Continuous  Positive  Airway  Pressure

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9  Ventilation- The mechanical exchange of air between the lungs and the atmosphere.  Pulmonary ventilation refers to the total exchange of gas.  Alveolar ventilation refers only to the effective ventilation within the alveoli.

10  Respiration- the exchange of oxygen and carbon dioxide between the atmosphere and the body cells  -Occurs at the alveolar level

11  Diffusion – the movement of gas from an area of higher concentration to an area of lower concentration. ◦ This is how respiration occurs

12  In order for respiration to take place and be efficient you must have: ◦ Functional alveoli and capillary walls ◦ An interstitial space between the alveoli and the capillary wall that is not enlarged or filled with fluid

13  Pulmonary perfusion- the process of circulating blood through the pulmonary capillary bed, in order for this to occur you must have: ◦ A properly functioning heart (Pump) ◦ Proper vascular size (Tank) ◦ Adequate blood volume / hemoglobin (fluid)

14  Asthma  COPD  CHF/Pulmonary Edema

15  A chronic inflammation disorder in the airways  Acute episodes “triggered” by something ◦ This releases histamine and leukotrienes causing  Bronchial smooth muscle constriction  Bronchial plugging from mucous secretion  Inflammation changes

16  Leads to increased resistance to airflow  Leading to hypoxemia and CO 2 retention which leads to hyperventilation and respiratory fatigue

17  Tripod position  Wheezing ◦ A silent chest is an ominous sound! ◦ Flow rates are to low to generate breath sounds  Inability to speak  Pulse > 130  Respirations > 30

18  Consider other causes for wheezing ◦ Pneumonia ◦ COPD ◦ Foreign body aspiration ◦ Heart failure ◦ Pneumothorax ◦ Pulmonary embolism ◦ Toxic inhalation

19  Chronic Obstructive Pulmonary Disease ◦ Chronic Bronchitis ◦ Emphysema

20  Inflammation of the bronchioles with large amounts of sputum present  Mucous obstructions ◦ Leads to gas trapping ◦ Leads to hyper inflation ◦ Leads to permanent damage  Short of breath due to mucous in alveoli

21  History of respiratory infection  Productive cough ◦ Large quantity of sputum  Short of Breath  Cyanosis

22 Mucous Air comes in, but can’t get out

23  A productive cough 3 months of the year for 2 consecutive years

24  Chronic disease  Results in destruction and loss of elasticity of the alveolar walls  Caused by: ◦ Cigarette smoking ◦ Exposure to unfriendly environment (ie: asbestos)

25  Skinny  Short of breath all the time  Shortness of breath worsens with any activity  Barrel chest  Long expiratory phase- pursed lips  Pink in color (polycythemia)

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27  Left ventricle unable to empty  Leads to increased pressure in left atria ◦ Causes increased pulmonary pressures which leads to fluid collecting in the lungs

28  Respiratory distress  Orthopnea ◦ Must sit or stand to breath comfortably  Spasmodic coughing (pink frothy sputum)  Paroxysmal Nocturnal Dyspnea  Apprehension (smothering feeling)  Cyanosis  Diaphoresis  Rales, possible wheezing  JVD

29  Vitals ◦ Increased B/P early (180’s/90’s) ◦ Decreased B/P later as patient tires ◦ Tachycardia ◦ Increased respiratory rate early (high 30’s) ◦ Decreased respiratory rate as patient tires

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31  Mask and head strap  Air filter  Hose  PEEP valves are separate

32  Positive  End  Expiratory  Pressure

33  PEEP is measured in cm of water  We use two different PEEP valves  7.5 (yellow) for COPD and asthma  10 (green) for CHF/Pulmonary Edema  If a pt. has a Hx. of COPD the 7.5 is used even if treating the pt. for CHF.

34  Used for COPD and Asthma  The lower pressure prevents alveolar damage to COPD pts. due to the loss of elasticity in the alveoli  If the 10 peep was used it could cause destruction of alveoli which would be detrimental to the pt.

35  Used for the treatment of CHF with pulmonary edema with no hx. of COPD  The higher pressure allows the fluid in the lungs to be returned to the circulatory system

36  Causes Venturi effect-Can generate large flows (140 L/min) with relatively little oxygen use. ◦ Mixes large quantities of ambient air with a little supplemental oxygen  FiO 2 ~30%

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38  It changes the partial pressure of oxygen in the blood  Deoxygenated blood has a lower partial pressure of oxygen than alveolar air so oxygen transfers from the air into the blood.

39  7.5 cm/H2O CPAP increases the partial pressure of alveolar air by approximately 1%  This increase in partial pressure ‘forces’ more oxygen into the blood  Even this small change in partial pressure is enough to make a clinical difference

40  Change the pressure gradient to force more oxygen into the blood  Maintain positive pressure in the lungs to force fluid out.  Prevents complete collapse of alveoli during exhalation allowing greater surface area for improved gas exchange.

41  Hypoxemia with signs and symptoms of COPD, CHF(pulmonary edema), or Asthma  Pt. must be breathing and able to protect their airway.

42  Penetrating Chest Trauma  Severe Hypotension  Persistent Nausea and/or Vomiting  Obtundation  Respiratory or Cardiac Arrest  Inability to Protect their own Airway

43  Hands on demonstration of the application of CPAP to follow at a later date.

44  Information for this PowerPoint presentation was obtained from: ◦ LEMS Clinical Care Guidelines ◦ Charlottesville Albemarle Rescue Squad


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