Continuous Positive Airway Pressure - CPAP

Indications

Any patient in respiratory distress who is suspected of having CHF/pulmonary edema, AND who is:

a. Awake and able to follow commands

b. Is over 12 years old and able to fit the CPAP mask

c. Has the ability to maintain an open airway

d. Exhibits any of the following

i. Respiratory rate > 25/minute

ii. SaO2 < 94% at any time

iii. Using accessory muscles to breathe

Contraindications

a. Respiratory arrest/apnea

b. Suspected pneumothorax or trauma to chest

c. Patient with tracheostomy

d. Patient with active vomiting

e. Any patient unable to tolerate the CPAP mask

Procedure

1. Explain the procedure to the patient

i. Re-evaluate for possibility of pneumothorax (ABSOLUTE CONTRAINDICATION)

2. Ensure adequate oxygen source attached to device

3. Place the patient on continuous oxygen saturation monitoring AND cardiac monitoring

4. Secure the mask in place covering the mouth & nose

5. Set CPAP pressure to 10 cm H2O

6. Check for air leaks and adjust mask as needed

7. Continue to coach and reassure the patient (especially if they are getting anxious)

8. Continue to reassess vital signs and patient’s response to CPAP every 5 minutes while enroute

9. Discontinue if patient cannot tolerate with coaching, has a significant decrease in level of consciousness, becomes apneic, or vomits.

COG's - CPAP Administration (google.com)