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CPAP Works Wonders

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Are there phrases you hate that have somehow invaded your vocabulary and now you find yourself using them despite the fact you hate them? Me too; I especially dislike "the best invention since sliced bread," or, "the best thing since peanut butter." Don't get me wrong, there's certainly a place in my pantry for sliced bread, but given my druthers, I much prefer to rip a hunk off a freshly baked baguette than undo a twisty tie, rip through cellophane and enjoy a slice of Wonder mush. And I like peanut butter too, but I don't really consider it to be one of humanity’s greatest achievements. Yet, sometimes I find those phrases coming out of my mouth before I can stop them. Or take my infectious buddy, Bob. He's always coming up with dumbass phrases. For example, for some unknown reason he started calling cheese "chez." Why? Who knows? He just does stuff like that. I thought it was stupid and annoying. Until one day I found myself standing in front of the fridge asking my wife, "Hey babe, we got any …?" Yeah, you guessed it.

The tones on my fire department pager went of for a difficulty breathing call. I pulled on my pants and shoes, lit up the blue light on my wackermobile and headed for the call. I was first on scene and directed by family to the mother-in-law "suite" behind the house. More like the mother-in-law dungeon from hell. At first I thought to myself, how can they let mom live back here like this? But once I got inside, I understood.

Places like this used to be experienced only by vermin, public safety and social workers. Now they're broadcast to the world on the TV show Hoarders. "Ma'am, where are you?" I called. "Back here," came the gurgling reply. "OK, I'm going in," I thought to myself, as I plunged into the stench and wended my way like a rat in a maze, following the oxygen tubing through mountains of newspapers and other jetsam stacked shoulder high with a narrow path snaking through the valleys to the bedroom at the back of the house.

And there it was: the all-too-familiar scene. Grandma was sitting on the bed with gritty nasal cannula in place, brown tobacco stained talons for fingernails, overflowing ashtray next to the bed and the ubiquitous used Kleenex strewn about. These sights and smells, in addition to the sound of the gurgling/rasping/hacking, make for the complete CHF/PE/COPD experience.

The ambulance crew arrived and we started the IV/02/monitor/nitro/lasix drill. I was an educator for EMS, and we had just completed initial training on our new continuous positive airway pressure (CPAP) protocols and devices. We hadn't yet used them in the field, and we had them set up for use with the onboard oxygen supply only. So we sat her bolt upright on the cot and somehow extricated ourselves from the maze.

Once in the ambulance, we began flailing with the hoses, tubes, filters, fittings, mask, and octopus-like head straps of the CPAP unit. We eventually got it figured out and placed on our patient's face—and then the miracle happened. Within seconds, our drowning, terrified, hypoxic patient relaxed, her 02 sat shot up into the 90s, and she sank back on the cot in relief. We continued with nitro every five minutes or so and got her pressure down by the time we arrived at the emergency department. After we finished writing our report, we dropped in to her room to say goodbye. Our patient was sitting up smiling with only a nasal cannula on, offering us her profuse thanks. What would surely have been an intubation and a significant ICU stay turned into an overnight observation with medication adjustment.

In the 25 plus years I've been doing this EMS gig, CPAP has got to be the best new invention in EMS since, well, you know, "chez."
 

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