Presentation on theme: "Pre-Hospital Treatment Using the Respironics Whisperflow."— Presentation transcript:
Pre-Hospital Treatment Using the Respironics Whisperflow
CPAP is an acronym for: Continuous Positive Airway Pressure
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.
Respiration- the exchange of oxygen and carbon dioxide between the atmosphere and the body cells -Occurs at the alveolar level
Diffusion – the movement of gas from an area of higher concentration to an area of lower concentration. ◦ This is how respiration occurs
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
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)
Asthma COPD CHF/Pulmonary Edema
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
Leads to increased resistance to airflow Leading to hypoxemia and CO 2 retention which leads to hyperventilation and respiratory fatigue
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
Consider other causes for wheezing ◦ Pneumonia ◦ COPD ◦ Foreign body aspiration ◦ Heart failure ◦ Pneumothorax ◦ Pulmonary embolism ◦ Toxic inhalation
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
History of respiratory infection Productive cough ◦ Large quantity of sputum Short of Breath Cyanosis
Mucous Air comes in, but can’t get out
A productive cough 3 months of the year for 2 consecutive years
Chronic disease Results in destruction and loss of elasticity of the alveolar walls Caused by: ◦ Cigarette smoking ◦ Exposure to unfriendly environment (ie: asbestos)
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)
Left ventricle unable to empty Leads to increased pressure in left atria ◦ Causes increased pulmonary pressures which leads to fluid collecting in the lungs
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
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
Mask and head strap Air filter Hose PEEP valves are separate
Positive End Expiratory Pressure
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.
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.
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
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%
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.
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
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.
Hypoxemia with signs and symptoms of COPD, CHF(pulmonary edema), or Asthma Pt. must be breathing and able to protect their airway.
Penetrating Chest Trauma Severe Hypotension Persistent Nausea and/or Vomiting Obtundation Respiratory or Cardiac Arrest Inability to Protect their own Airway
Hands on demonstration of the application of CPAP to follow at a later date.
Information for this PowerPoint presentation was obtained from: ◦ LEMS Clinical Care Guidelines ◦ Charlottesville Albemarle Rescue Squad