CPAP and administeration of oral medications
Posted 22 October 2012 - 04:37 AM
The real question you pose is : Should CPAP be removed to administer oral medications?
First we must point out what CPAP is doing in layman's terms.
Continuous positive pressure in the incidece of COPD exacurbation is somewhat "splinting open" the airways by removing the negative pressure phase on inspiration.
The second mechansm is to re-recruit collapsed alveoli, again through positive pressure.
So, the question of removing the CPAP.
As we can see above, CPAP itself is a great temporizing measure to open up the airways, and allow better gas exchange. We must realize thoug that it is only a temporary fix. It can make a very sick patient appear well however if we do not fix the real problem (bronchospasm/secretions), then eventually the patient will decompensate...... or need CPAP for a very long time!
So you need to do a risk/benefit anaysis of your oral meds. By remoing the mask temporarily, some alveoli may re-collapse, the splinting of the airways will cease and the spasm will begin to dominate once again. That said, the speed in which this takes place will be patient dependant. However, if they die of an MI with no treatment, none of it will really matter!
This is the beauty of ALS, you post a clear cut question, and get no answer!!
I will always remove the mask to administer nitro/ASA/Plavix. For the few seconds it takes, even in full pulmonary edema, I have yet to find literature that supports continuous CPAP sans all other treatment.
Forgot to mention: Nitro drips and CPAP work nicely together fo Pulm edema!
I would do the same in this scenario. A spray or two, then start a drip.
If there was suspicion of a preload dependant blod pressure, I would (and have) forgone the spray, and just start low dose drip.
Posted 22 October 2012 - 04:48 AM
Is there something going on with the alveoli specifically as well?
Posted 22 October 2012 - 09:00 AM
Either streptokinase alone, or ASA alone, reduced the 5-week mortality by 25%. Given together, there was an even greater reduction.
From this, and later studies, came our current treatment options. As chbare said ASA is absolutely vital.
Posted 22 October 2012 - 11:52 AM
Mobey, I wish that we had Nitro IV on car, during the scenario I said I would give my Nitro either as a nitro patch or through IV infusion to minimize interruptions, but of course it was the program head evaluating me, so of course, he wanted a clear answer as to whether I would take the mask off or not.
After reading a few responses and doing some research, I think I just really have to change my thinking as to what is BEST for the patient, and if that ASA is what stops that ischemia from progressing to infarct, I can't stand here and say it would be the right thing to withold that treatment from the patient.
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