1. Pre-Hospital Treatment Using the Respironics Whisperflow
CPAP
Pre-Hospital Treatment
Using the Respironics Whisperflow

2. CPAP-What is it? CPAP is an acronym for: Continuous Positive Airway
Pressure

3. Anatomy Review

4. Anatomy Review

5. Alveoli

6. Chest Wall

7. Normal Respiration

8. Physiology Review
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.

9. Physiology Review
Respiration- the exchange of oxygen and carbon dioxide between the atmosphere and the body cells
-Occurs at the alveolar level

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

11. Diffusion
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

12. Pulmonary Perfusion
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)

13. What do we use CPAP for?
Asthma
COPD
CHF/Pulmonary Edema

14. Asthma 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

15. Asthma Leads to increased resistance to airflow
Leading to hypoxemia and CO2 retention which leads to hyperventilation and respiratory fatigue

16. Asthma Pt. Presentation
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

17. Asthma- Differential Diagnosis
Consider other causes for wheezing
Pneumonia
COPD
Foreign body aspiration
Heart failure
Pneumothorax
Pulmonary embolism
Toxic inhalation

18. COPD Chronic Obstructive Pulmonary Disease Chronic Bronchitis
Emphysema

19. Bronchitis
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

20. Bronchitis Pt. Presentation
History of respiratory infection
Productive cough
Large quantity of sputum
Short of Breath
Cyanosis

21. Bronchitis Pt. Presentation
Mucous
Air comes in , but can’t get out

22. Bronchitis “Blue Bloater”
A productive cough 3 months of the year for 2 consecutive years

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

24. Emphysema Pt. Presentation
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)

25. Emphysema- “Pink Puffer”

26. Congestive Heart Failure (CHF)
Left ventricle unable to empty
Leads to increased pressure in left atria
Causes increased pulmonary pressures which leads to fluid collecting in the lungs

27. CHF Pt. Prsentation 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

28. CHF Pt. Presentation 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

29. Respironics Whisperflow CPAP

30. Whisperflow Kit Contents
Mask and head strap
Air filter
Hose
PEEP valves are separate

31. PEEP
Positive
End
Expiratory
Pressure

32. How PEEP is Measured 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.

33. 7.5 PEEP 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.

34. 10 PEEP
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

35. How it works-Mechanically
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
FiO2 ~30%

36. Oxygen Consumption

37. Physiology of PEEP
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.

38. Physiology of PEEP (cont.)
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

39. Goals of CPAP
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.

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

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

42. Application of CPAP
Hands on demonstration of the application of CPAP to follow at a later date.

43. References
Information for this PowerPoint presentation was obtained from:
LEMS Clinical Care Guidelines
Charlottesville Albemarle Rescue Squad