After seeing a variety of inquiries around the potential offers for CPAP in COVID-19 treatment, we reached out come znjke.com contributors native the Montgomery ar Hospital District, Robert Dickson, MD, FAAEM, FACEP, FACEM, MCHD medical director; and also Casey Patrick, MD, MCHD assistant clinical director, to get their take.

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“The COVID-19 pandemic has compelled EMS and all emergency providers to reassess our approach to airway management and treatment. This is specifically true once we must care for patients through cough, fever and difficulty breathing, prior to learning their contagious status,” Dr. Dickson said. “Coronaviruses room transmitted via patient droplets. However, prehospital providers have the right to increase the risk of viral infection by aerosolizing patient droplets.” This is assumed to take place in number of situations, that noted, including:

SuctioningIntubationUtilizing a BVMDuring non-invasive confident pressure ventilation (NIPPV)With high-flow oxygen usage (>6L/min)When administering nebulized medications.

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uncover COVID-19 break news, what EMS demands to know around the novel coronavirus and tips because that EMS leaders in how to prepare for and also educate top top the COVID-19 pandemic below


“The bottom line is to protect against all nebs in patients who room not in open minded respiratory failure – and, if you have actually to offer them – carry out it “in line” with NIV, only if you have actually the suitable kit through filter.”

Dr. Patrick agrees. “I would protect against NIPPV if at all possible. From every the an essential care info I’ve read (e.g., PulmCrit/EMCrit, and also various anesthesia society recommendations) it appears that they also prefer high circulation nasal cannula (HFNC) come NIPPV (not that we have access to HFNC in the field). I would stick come If the answer come No. 1 is yes, climate I desire to have actually a system set up with a famous filter together close to the patient as possible. Also, I desire the system to be as closed-circuit as possible with secondary viral filter ~ above the inhalation limb together well. Ideally, NIV would certainly be used in a an unfavorable pressure/flow environment also (realizing the these stipulations are often not easily accessible on the ambulance).

If you decision to usage CPAP/NIV, be certain to placed a operation mask over the NIV mask for second layer the protection, he cautioned.

“It appears that COVID patients demonstrate ‘silent’ hypoxia and atalectasis, i beg your pardon is seen clinically v oxygen saturation worths in the mid/low 80s v minimal distress,” Dr. Patrick reported. “In the EMS setting, we must be vigilant in treating patients and also not numbers. If a patient is reasonably comfortable and also hemodynamically steady at 82% ~ above 4L NC, climate in the age of COVID-19, much less is more. Carry and allow the ED/ICU persons to more sort the patient (HFNC likely). Execute not more increase famous transmission threat to deal with an O2 sat value.”

How to safeguard yourself during airway interventions

MCHD common the complying with video, in i m sorry Dr. Dickson and also MCHD Paramedic Brad Ward talk about how providers have the right to stay for sure while caring for respiratory fail patients. The strategy behind minimizing risk of any aerosolizing is focused on one of two people filtering the exhaled air or using a surgical mask obstacle to save on computer potential airborne viral particles as soon as utilizing high circulation oxygen by challenge mask.

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“We room all functioning without a net in the era that COVID-19, together this is a brand-new world for everyone. This no the just way, it’s simply MCHD’s best means following synthesizing heaps of existing data and best practice guidelines. There are many new methods and also ideas neighboring airway management and also preventing aerosol-generating procedures. Teamwork is key, so please reply and share any type of variations or various other protocols you may be utilizing in your service.”

Additional COVID-19 airway monitoring resources

Learn an ext about safety precautions for ventilating patients v COVID-19 through these resources from Montgomery county Hospital District:


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Kerri Hatt is editor-in-chief, znjke.com, responsible for defining original editorial content, tracking sector trends, managing expert contributors and leading execution of one-of-a-kind coverage efforts. Before joining Lexipol, sheserved together an editor for medical allied wellness B2B publications and also communities.

Kerri has a bachelor's degree in English from Saint Joseph's University, in Philadelphia. She is based the end of Charleston, SC. Share your an individual and firm successes, strategies and stories through Kerri in ~ khatt