NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 60-year-old male with a history of heart failure presents with acute onset of severe dyspnea, orthopnea, and pink, frothy sputum. Auscultation reveals diffuse crackles (rales) bilaterally. His SpO2 is 85% on room air. What is the MOST appropriate initial ventilatory support?
- ANasal cannula at 6 L/min.
- BNon-rebreather mask at 15 L/min.
- CContinuous Positive Airway Pressure (CPAP).
- DBag-valve-mask ventilation.
Show answer & explanationAnswer & explanation
Correct answer: C. Continuous Positive Airway Pressure (CPAP).
The patient's presentation (heart failure, severe dyspnea, orthopnea, pink frothy sputum, diffuse crackles, and hypoxemia) is classic for acute pulmonary edema. CPAP is the most appropriate initial ventilatory support as it helps to force fluid out of the alveoli, improve oxygenation, and reduce the work of breathing without requiring intubation.
Why the other options are wrong
- A. Nasal cannula provides insufficient oxygen and no positive pressure for severe pulmonary edema.
- B. A non-rebreather mask provides high FiO2 but does not provide positive pressure to help move fluid out of the alveoli.
- D. BVM ventilation is for apneic or severely hypoventilating patients; it's not the first choice for a spontaneously breathing patient in pulmonary edema who needs continuous positive pressure.
CPAP for Pulmonary Edema
Continuous Positive Airway Pressure (CPAP) is a cornerstone of prehospital management for acute pulmonary edema. It reduces the work of breathing, improves oxygenation, and helps to shift fluid from the alveoli back into the capillaries.
- Indicated for acute pulmonary edema, especially with hypoxemia.
- Provides continuous positive pressure throughout the respiratory cycle.
- Benefits: improved oxygenation, reduced preload/afterload, decreased work of breathing.
- Contraindications: hypotension, altered mental status, facial trauma, pneumothorax, vomiting.
Memory trick: When lungs are wet and breath is short, CPAP's the best support.