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CPAP and administeration of oral medications


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#1 J306

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Posted 21 October 2012 - 10:08 PM

I had a scenario the past week involving an exacerbation of emphysema which I decided to treat with Nebulized Ventolin through the CPAP mask along with Solumedrol. My instructor decided to introduce a new onset of Angina with Ishemic changes in leads II, III and aVF.

He asked me how I would treat the new onset of symptoms to which I replied I would administer 2.5mg of Morphine SIVP. He challeneged me to consider the administration of ASA and Nitro which would require me to remove the CPAP device.. I stood behind my decision to keep the CPAP device on my patient as the COPD exacerbation was the primary complaint, and there's also a risk to the patient in removing the mask once it is applied, and the angina is secondary and can be relived by the morphine.

Just curious as to what some other opinions of this would be?

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#2 chbare

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Posted 21 October 2012 - 11:48 PM

With elevation in said leads, you had best do additional investigating before giving preload reducing agents such as nitroglycerine. Aspirin is absolutely needed assuming no contraindications.
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#3 J306

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Posted 22 October 2012 - 12:37 AM

Yes, absolutley would be cautious in administering nitro to a patient with inferior wall ishemia, I would have done a right sided 12-lead to get some additional views prior.. I did not give ASA because of the risk/benefit of removing the CPAP device. To be completely honest, I don't really know if it is common practice to temporarly remove the mask to give oral medications.
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#4 chbare

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Posted 22 October 2012 - 12:42 AM

In the case of Aspirin, it's one of the only interventions available to us that actually decreases morbidity/mortality in these kinds of patients, so I think you could put up a strong argument for ASA use.
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#5 paramedicmike

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Posted 22 October 2012 - 12:46 AM

To add to what CHBARE said, not only is ASA one of the only medications available to us to reduce morbitity and mortality, but there is some evidence to suggest that morphine makes it worse. Taking care of the pain does not end the ischemia, which is how I read your comment about angina being relieved by morphine. Morphine relieves the pain. It does not stop the damage.

Good question.
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