This document discusses congestive heart failure (CHF), pulmonary edema, and the use of CPAP to treat patients experiencing acute pulmonary edema due to CHF. It provides an overview of cardiac physiology and the pathophysiology of CHF. CPAP is presented as a non-invasive treatment that can open collapsed airways and reduce work of breathing. Guidelines are given for appropriate prehospital patients and how to apply and monitor CPAP. Studies show CPAP can improve respiratory status and reduce intubation rates, ICU admissions, and hospital stays compared to traditional oxygen therapy alone.

1. Congestive Heart Failure, Pulmonary Edema, and CPAP James Pointer, MD, FACEP Medical Director Alameda County EMS

5. People Live With Atherosclerosis – But Die of Thrombosis! Arteriosclerotic plaques gradually narrow the coronary arteries, but it is a rupture of the plaque and subsequent platelet aggregation and thrombosis that occludes the artery. Acute Myocardial Infarction

10. CHF Vicious Cycle Low Output Increased Preload Increased Afterload Norepinephrine Increased Salt Vasoconstriction Renal Blood Flow Renin Angiotension I Angiotension II Aldosterone

13. Acute Pulmonary Edema a true life- threatening emergency

31. CPAP Study 1996 – 1997 1997 – 1998 September – May September – May Intubated 22 8 CPAP 0 50 Hospital Stay(d) 14.8 8 ICU Admission 100% 48%

33. Alameda County CPAP Policy