This morning we had a call for a 70 year old man with dsypnea and found him guppy-breathing with a BP of 210/100, HR – 144, skin ice cool and clammy, unable to get a SAT, ETCO2 of 50, RR of 32. Wheezes and crackles in lungs. Upright CO2 wave form.

He was sitting on his front steps, probably hoping the fresh air would help, but it wasn’t. We threw him on the stretcher and got him in the back of the ambulance quick.

We put him on CPAP — first time for me (we’ve only had it a couple weeks) — and started pounding in the nitros and in no time he was warm and dry. RR down to 24, ETCO2 down to 34. HR down to 132. He was still full of fluid, but at least we weren’t having to intubate him. Niether did the hospital. They put him on bi-pap and a nitro drip. His PH was 7.25 on arrival. The doctor said he probably would have coded if we hadn’t gotten there and started treating him as soon as we did.

I was trying to imagine how the call would have gone if we didn’t have CPAP. The nonrebreather wouldn’t have helped much. We had it on for about a minute before we got the CPAP out and he was tearing it off gasping that he couldn’t breathe. We would have had to start bagging him and maybe dropped a tube. Much more invasive than putting the CPAP on.

I saw him later in the hospital and they had him down to a Venturi mask and he was sleeping comfortably.

I made sure to thank our medical control doctor and clinical coordinator for helping us get CPAP. It certainly made a big difference — just as advertised.

Here’s an article from JEMS about the type of CPAP (Boussignac) we have.

Hands On: 10 cm of CPAP In a 10-oz. Package


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  • Anonymous says:

    Did you run in to problems with the O2 running out too quickly with the Boussignac during the call? My system is recommending people purchase CPAPos by Emergency Medical Technologies since it lasts ~40 minutes on a D cylinder.Were you able to catch any waveforms of the pt while undergoing CPAP?

  • PC says:

    No, I didn’t have a problem. Since we had the patient in the ambulance quickly, we started off the main and then switched to the portable at the ED.What’s nice about this system is its just a mask that you hook up to your tank. No gadgets or dials. I would recommend having a second portable available just to make it easy if you run low in one.Unfortunately in the heat of the call, I didn’t get the best capnography strips. The ones I printed out were lost in the cleanup. I got two off the code summary, but they have a lot of artifact. I wish we had gotten the capnography on initially rather than shortly after we applied the CPAP. The ETCO2 readings were pretty good(they did not fluctuate wildly — improving steadily from 50 down to the low 30’s, except at one point when the cannula became dislodged.

  • RevMedic says:

    We’ve got the Boussignac system, too. It’s absolutely amazing how well and how fast it works. One day this will catch on!

  • Anonymous says:

    “Hands on 10cm of CPAP” sounds like a junk email I got the other day.I can see it:PARA M3DICS! ETT, N1TRO, CP4P. No prescription Needed! EHNANCE YOUR VIRILITY WITH mission Impossible cpAP. Make THEM BREATH AND TALK LIKE NEVER BEFORE.

  • Parameddan says:

    It’s good to see CPAP being used in prehospital care. The last patient I had was a 44 yr old male with Asthma. Initial ETCO2 was 76 but decreased to 32 after three minutes of CPAP. Excellent tool for those difficult breathers.

  • Mia says:

    Hey, interesting blog.. I just happened to surf in.One question. What IS guppy breathing?I was in a bad situation once.. remember seeing it written on my chart. Always been curious.. but I’m thinkin’ it probably isn’t somethin’ good 🙂

  • PC says:

    Guppy breathing is similar to a fish out of water, gasping ineffectively.

  • Jack says:

    If anonymous wasn’t anonymous they could get some training and education and enjoy the clinical benefits to their patient

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