Question: If respirations are at or above 28, historically paramedics are taught to assist via BVM. What is the rationale with pulmonary edema to apply NRB with tachypnea instead of assisting with a BVM until CPAP and or nitro is prepared?

The SWORBHP Medical Council does not entirely agree with the teaching that a patient with a respiratory rate at or above 28 requires assistance with ventilations using a BVM. Paramedic clinical judgment and other assessment factors should lead a paramedic to determine that the use of a BVM is required.

In the BLS Patient Care Standards, a patient who is short of breath should have ventilations assisted if breathing is deemed inadequate as evidenced by signs and symptoms of hypoxia (e.g. decreased LOC, cyanosis).

Basic Life Support Patient Care Standards- January 2007, Version 2.0, Section 2-Medical Patient Categories, page 46, Shortness of Breath, Breathing Difficulty in Adults and Children €“Not Related to Trauma

Therefore to answer your specific question, if a paramedic based upon clinical judgment feels that a BVM is indicated to support a patient with respiratory distress and inadequate ventilations, then it is entirely appropriate to do so while preparing the CPAP. It is also acceptable to administer high concentration FIO2 via a NRB if the clinical judgment of the paramedic on scene if ventilations are assessed to be adequate.

Acute Cardiogenic Pulmonary Edema,Airway/Breathing,Cardiac/Circulation,Continuous Positive Airway Pressure (CPAP)

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