Date of Issue: 07/01/2019
Respiratory Distress – Pulmonary Edema/CHFScope:This clinical protocol applies to all agents of a department that receive Medical Direction through the Virtua Health MORE Program. Responsibility:All personnel from a department that receives Medical Direction through the Virtua Health MORE Program are the adhere to this protocol. The Medical Director or his/her designee(s) will be responsible for assuring compliance through direct observation, feedback and quality assurance reviews, which the assistance of the department’s management team. Unusual occurrences involving patient care will be reported to the NJSDOH-OEMS in compliance with N.J.A.C. 8:40-3.5.Procedure: Conduct scene size-up, primary assessment, and immediate lifesaving interventions. Have an airway adjunct, ventilation and suction device nearby and ready for use. Promptly administer oxygen as tolerated by the patient, titrate with pulse oximetry to desired SpO2 of ≥94% and ≤99%. Place the patient in a position of comfort (preferably seated in fowler’s position).Ensure ALS response.Obtain baseline vital signs, SAMPLE and OPQRST history, and conduct secondary assessment.If patient is awake, spontaneously breathing in respiratory distress associated with Pulmonary Edema and is ≥18 years of age, BLS start Continuous Positive Airway Pressure (CPAP) if no contraindications are present. ONLY CPAPs APPROVED BY THE MEDICAL DIRECTOR AND SUPPLY BY YOUR DEPARTMENT CAN BE USED.Administration:Set CPAP to 10cmH2OBrief patient on what to expect and how to cooperate when CPAP mask is appliedAssemble and supply O2 to CPAP device according to manufacturer’s specifications.Assure a snug fit of CPAP mask and adequate O2 supply.Reassess for tolerance of therapy, gastric distention, respiratory fatigue or failure, hypotension and SpO2 desaturation.Be prepared to abandon CPAP and provide original O2 therapy or assisted ventilations.Ensure receiving facility is notified that the patient is on CPAP. This can be done by ALS if available. WHEN QUESTIONS OR CONCERNS ARISE, CONTACT MEDICAL CONTROLSigns and Symptoms of Acute exacerbation of Bronchoconstriction/COPD/AsthmaShortness of breathOrthopnea (increased distress when supine)Air hungerSensation and appearance of drowningAcute onsetRalesTachypneaPink frothy sputumTripod positionHypertension, often severeLow extremity edemaWheezingContraindications:Respiratory failure or apneaHypotension (SBP <100mmHg)PneumothoraxFacial, laryngeal, or pulmonary traumaTracheoesophageal fistulaRecent tracheal, esophageal, or gastric surgeryActive or anticipated vomiting or upper GI bleedingFailure to tolerate or completely seal CPAP maskAdverse Effects:ClaustrophobiaEpistaxisChest discomfortExcessive coolingNausea/VomitingSinus discomfortDifficulty exhalingCardiac arrhythmiaPneumothoraxPneumomediastinumEdemaAerophagiaSubcutaneous emphysemaMandatory Documentation:Note therapy, CPAP pressurePatient responseHospital Notification, if not done by ALS. ................
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