This morning we had a call for a 70 year old man with dsypnea and found him guppy-breathing with a BP of 210/100, HR - 144, skin ice cool and clammy, unable to get a SAT, ETCO2 of 50, RR of 32. Wheezes and crackles in lungs. Upright CO2 wave form.
He was sitting on his front steps, probably hoping the fresh air would help, but it wasn't. We threw him on the stretcher and got him in the back of the ambulance quick.
We put him on CPAP -- first time for me (we've only had it a couple weeks) -- and started pounding in the nitros and in no time he was warm and dry. RR down to 24, ETCO2 down to 34. HR down to 132. He was still full of fluid, but at least we weren't having to intubate him. Niether did the hospital. They put him on bi-pap and a nitro drip. His PH was 7.25 on arrival. The doctor said he probably would have coded if we hadn't gotten there and started treating him as soon as we did.
I was trying to imagine how the call would have gone if we didn't have CPAP. The nonrebreather wouldn't have helped much. We had it on for about a minute before we got the CPAP out and he was tearing it off gasping that he couldn't breathe. We would have had to start bagging him and maybe dropped a tube. Much more invasive than putting the CPAP on.
I saw him later in the hospital and they had him down to a Venturi mask and he was sleeping comfortably.
I made sure to thank our medical control doctor and clinical coordinator for helping us get CPAP. It certainly made a big difference -- just as advertised.
Here's an article from JEMS about the type of CPAP (Boussignac) we have.
Hands On: 10 cm of CPAP In a 10-oz. Package
