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Clinical Indications:

    > 16 year old

    Alert with an intact airway and ventilatory drive

    Respiratory distress in the conscious patient with impending respiratory failure (accessory muscle use, retractions, abdominal breathing, tri pod position, unable to speak full sentences.

    Room air SaO2

    Refractory to conventional O2 (does not respond to oxygen via NRM, minimal or no improvement in SaO2).

    Tachypnea, RR > 24

    Presumed Pulmonary Edema
    Presumed COPD
    Presumed Asthma
    Presumed Near drowning

    Clinical Contra-Indications:

    Hypotension (SBP

    Aspiration risk

    Need for immediate airway control (non responsive)

    Upper airway abnormalities or obstruction

    Altered mental status GCS

    AMI or unstable cardiac arrhythmia

    Extreme anxiety


      1. Check oxygen supply, set up CPAP and connect circuit to oxygen source.source.

      2. Prepare intubation equipment so it is set up should it be needed.

      3. Explain procedure to patient.

      4. Place CPAP mask over the patient’s mouth and nose.

      5. If medication is indicated i.e. NTG administer prior to securing mask.

      6. Secure mask with provided straps and ensure there is an airtight seal. Some patient’s may need coaching or may need to hold the mask themselves prior to securing straps to avoid anxiety.

      7. For Pulmonary Edema start with a 10 cm PEEP valve. If patient is not tolerating CPAP switch to 7.5 cm PEEP valve.

      8. For COPD, Asthma and Near Drowning start with a 5.0 cm PEEP valve. If no improvement and patient is tolerating CPAP increase PEEP to a 7.5 cm valve.

      9. Monitor patient’s respiratory status and vital signs with frequent reassessment. If the patient’s respiratory status does not improve remove CPAP, assist ventilations with a BVM and consider intubation.

      10. Document time and response on patient care report (PCR)

      11. In case of complications discontinue treatment and follow appropriate protocol.

    Certification Requirements:

      Successfully complete an annual skill evaluation inclusive of the indications, contraindications, technique, and possible complications of the procedure.

    Set Up Photos

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