This is the CPAP and PEEP skill.
Our first step is going to be take our standard precautions.
For this skill we will need eye protection and gloves.
From there we want to ensure our patient has an adequate blood pressure.
We also want to then sit them in a high fowler's position
to ensure ease of ventilations.
From there we are going to look for indications for CPAP.
our indications are Congestive heart failure
Pulmonary edema, Pneumonia
Asthma and COPD.
After assessing for indications for CPAP
we are now going to assess for contouring indications
The contouring indications are unconsious, unresponsive
The inability to speak or control your own airway
the inability of sit up
respiratory arrest or agonal respirations
nausea and vomitting
hypo tension with a systolic below 90
suspected pneumothorax
cardiogenic shock
penetrating chest trauma
facial anomalies including burns and trauma
a closed head injury
an active upper GI bleed or recent gastric surgery
Now we are going to gather and assemble our equipment for CPAP.
The equipment that we are going to need is an o2 supply,
hoses and tubing,
a CPAP machine,
our CPAP mask with head straps
and our etco2 nasal cannula.
From there we are going to coach our patient on how to use the CPAP mask.
we'll then attach our oxygen supply to the CPAP machine
as well as the breathing portion of the CPAP machine
and then turn on the o2 in the machine.
we'll then set the device parameters according to our local protocols
and our manufactures recommendations.
Recommended device parameters are
Turn the rate dial to 8 to 12 per minute
Turn the oxygen concentration dial to the lowest setting
between 28 and 29 percent oxygen.
Titrate oxygen concentration to achieve an SPO2 greater than 94 percent.
Set title volume to 10 to 12 milliliters per kilogram.
Set pressure relief valve at plus or minus four centimeters H2O.
Occlude tubing to test for peak pressure required to activate pressure relief valve
and adjust as necessary.
After our CPAP machine has been assembled
we are going to go ahead and turn our oxygen on.
From there were are going to take our CPAP mask
and we are going to place it over the nose and mouth of the patient
while making sure the end-tidal CO2 nasal cannula stays in place.
We are then going to titrate our machine to the desired setting
and then coach the patient to breathe normally and to adjust the air pressure
while securing the mask.
After the CPAP mask has been placed appropriately
we are going to frequently assess our patient for desired effects
such as decreased ventilatory distress
decreased adventitious lung sounds
absence of complications such as barotrauma and a pneumothorax
and an SPO2 greater than 94 percent.