#CPAP and respiratory

[tricaremedical]

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[cerecdepot]

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[mideltainternational]

Yuwell BreathWear YN02 Nasal CPAP Mask Available . . . 📞9811464331/ 081303 00415 📩marketing.midelta@gmail.com

[briarpatch-kids]

Looks like you can buy "cpap" specific creams as well that are petroleum free if you don't want use a petroleum based cream like aquaphor or Vaseline.

Hi! I have a CPAP and getting moved to a BiPAP. I know that isn’t NOT AT ALL the same as your ventilator, but I think the mouthpiece/nose pieces are made out of the same material. Do you have issues with contact dermatitis? I’m getting eczema patches around where the nose/mouth pieces are, and I’m not really sure what to do. Ive talked to my doctors about it too, and they said as long as it isn’t painful, the best option may just be putting up with it because all of the soft ones are made of the same material. I’ve had it for over a year, so I don’t think time will resolve this unfortunately.

I hope you find the bipap easier to breathe with, I know I did! I don't normally have skin issues with my mask, but there's a nasal mask called the resmed airfit p10 that only touches the inside of your nostrils rather than the area around your nose and you might find that better for your skin. I kept getting the leak alarm going off, but your machine may not have that problem with the mask. (If it does the problem is not enough air leaking rather than too much) Another thing that might be worth trying is something like aquaphor applied around where the mask touches before you put it on to provide a barrier between the mask and your skin.

[ainawgsd]

Here's hoping I come home with a CPAP machine this afternoon. I saw my sleep dr yesterday for the follow up on my sleep study back in October (!) According to my sleep study I stopped breathing an average of 9 times an hour with oxygen saturation dropping as low az 79%! I got set up with the respiratory therapist this morning. I might cry if they have to order it and ship it to me.

[faggotisaacfloofs]

ok it appears respiratory nurse was wrong and sleep study did have usable results!!

still haven't heard from the dr but reading the report, it says i had 15 hypo-apneas per hour (normal is <5) and that and many events of low oxygen below 89% for more than 5 minutes at a time

I spent 41 minutes of the 4 hours with my oxygen below 90%, often down to 84%

So it says i am diagnosed with moderate sleep apnea and need to do the followup in 2 weeks to get fitted with mask and stuff???

What i am confused about is that it said a lot of my low oxygen events were when I was not having an apnea/hypo-apnea event?? Which to me seems to indicate with my belief that there is something else going on with my breathing (but dr won't investigate til I am on cpap!!! Because assume it is all sleep apnea even when i struggle with breathing while awake!) But maybe I don't know enough. Idk.

So i guess wasn't total bust?

I do not know how i can possibly tolerate sleeping with a sleep apnea mask but I guess I will have to try. And I have to do another goddamn sleep study.

[lleeckina]

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[nightingalesandnorco]

Hello and thank you for your service!

I have a specific question about oxygen and nebulisers when someone is treated for asthma in the ER. Will both be used at the same time? Like, will the patient get a nasal cannula for oxygen and nebulised medication with a mouthpiece at the same time, will they alternate between giving medication and oxygen, will they give oxygen by the same mask they use for the nebuliser?

And what if the patient is in or is nearing respiratory failure. Will NIV be used for asthma patients? Or high-flow oxygen? How will their breathing be supported when their breathing muscles get fatigued from the effort it takes to breathe? How will nebulised medicine be given to the patient that’s needing support to breathe from a ventilator? Or do you stop with nebulised albuterol and other medications once they are on a ventilator and just use IV meds to open up the airway?

Happy to help!

Medications like albuterol are nebulized with oxygen so the patient will always be getting both at the same time from the same mouthpiece or mask.

If a patient goes into respiratory distress as a result of asthma exacerbation, high-flow oxygen with a nonrebreather mask (see the image below) or noninvasive ventilation with CPAP or BiPAP will likely be used.

The specific method used will be chosen by the doctor or respiratory therapist. If a patient's breathing muscles are fatigued to the point that they are struggling to breathe on their own, they’re in respiratory failure and will likely receive noninvasive or invasive ventilation. If the patient is continuing to desat and all other methods of oxygen delivery have failed, the patient will likely be intubated and put on mechanical ventilation. If an intubated patient needs inhaled medications, they will be nebulized through the ET tube. Albuterol is the most effective med for opening the airway, and though it's available by a few different routes, it's almost always given by inhaler or nebulizer. Steroids like methylprednisolone can also be given, and always by IV. A patient with an asthma exacerbation will most likely receive both.

Happy whumping!

[carnelianfoxx]

When I got my auto-cpap machine and he turned it on and I tried breathing with it for a minute, I noticed I felt kinda... weird? Like I was hyperventilating, but I was breathing at a normal rate? So I asked "is it normal to feel light-headed?"

and the respiratory therapist was like "it's because your brain is oxygen deprived and you're actually being oxygenated, so your brain chemistry isn't used to it"

so i think this is gonna be literally life changing

[gallifreyshawkeye]

It's a weird feeling to know you've stepped into the breach, as it were. Stepped between someone and death itself and were definitively the reason that person did not die. It actually happens significantly less in my job (as a paramedic) than you'd think.

Most of the time people call us because they simply want to "get checked out", or they can't tolerate throwing up after four hours and puking a couple times. Or it's for a real medical/injury thing, but it definitely wasn't a life and death matter. Or it it is a life and death matter and there wasn't any real chance of tipping the scales of life in their direction from the outset. But every once in a rare while, we get to be that person in the unique right situation and unique exact moment to be the reason someone doesn't die just yet.

I had a call yesterday where someone with underlying, chronic breathing problems tried toughing out significantly increased trouble breathing for a week before finally being unable to tolerate it any longer and calling 911. From the time we showed up on scene to the time our patient had completely fatigued on the way to the hospital and I had to hook up advanced equipment, even after giving them medications and the whole nine yards, was only 20min!

That's it.

That's how close they were to dying if they hadn't called when they did.

And I don't know, I've been doing this for 20yrs now. On the technical side of things I don't have to think twice. I can be recognizing all the intangibles that indicate impending respiratory failure even though all the numbers on the monitors haven't budged and are technically fine and be reaching for the CPAP while pulling out my phone to call the hospital and update/upgrade all at the same time without consciously spending any time deciding any of those courses of action. And yet in retrospect, the significance of those actions and decisions is actually huge.

It's not in the least that I'm psyched out by out it. More kind of.... stunned disbelief? sometimes of the position I find myself and just how unphased I am by it, and yet how huge and privileged of a position it really is sometimes.

[dragonbleps]

Dad's all settled in the ICU and said he already feels more confident with how coordinated the nurses and doctors are, so that's a nice sign. The nurse seems very kind and attentive and not dismissive like some of the others

We're just waiting for the doctor to come in and the Respiratory person to hook up his Cpap so he can sleep

[briarpatch-kids]

hi, i love your blog!

no pressure to answer this if no energy or if it's too personal!

I was curious about your ventilator, as I have some similar health issues i think (I have severe ME/CFS, with weakness requiring power chair & often being too weak to breathe well--my O2 is good but I can get out of breath from the overexertion it takes to breathe, haha)

I searched and can't find what the ventilator is specifically for (maybe I'm just not seeing it)

If you're okay answering, what is the ventilator for, and maybe what was the process of getting it? How much does it help?

Thank you, no pressure, appreciate your blog, have a lovely day!!! 💖

It's for co2 build up due to mitochondrial disease weakening my trunk muscles including my diaphragm. I don't breathe often enough or deep enough, so while my oxygen is good, I get paranoid and start to hallucinate. I also just kinda... blank out and spend a lot of time in a haze without it as well. Plus, any kind of respiratory illness just takes forever to go away and turns into pneumonia really quick. (Took me four days to go from rsv to pneumonia, and my oxygen sats dropped to 90 while I was sick for example.)

I would look into getting a sleep study and/or a pulmonary function test if you think you might need one, generally it shows if you aren't breathing enough and shows how your breathing changes when you fatigue. I went from needing a cpap at night only, to needing a bipap at night and having to use it more and more often during the day, to needing a ventilator on bipap 24/7. A lot of people who fatigue out like that, using bipap at night gives your muscles enough of a break and they won't need a portable ventilator during the day. I'm just kind of a weird case because I have a neuromuscular disease.

[maryellencarter]

okay so! As I mentioned, I have the Covid. Given how much shared air I have to breathe while being homeless, it was probably inevitable.

My blood oxygen is good, I'm not feverish, and I don't seem to have any complications (yet). My main symptom is a horrible hacking cough that feels like dry heaves but in my lungs, along with just enough sniffles that my nose is getting raw from blowing it on terrible shelter toilet paper.

(Weirdly, I feel fine when I'm not coughing. I can even sing. But the coughing gets worse when I lie down and a lot worse with my CPAP mask on, so sleeping is an adventure.)

I was able to get temporary state insurance to cover the hospital visit and the Paxlovid at no cost to me. But there's nowhere I can isolate. The hospital didn't even keep me overnight.

I can still sleep in the shelter bunkroom as long as I keep my mask on except when I change to my CPAP mask for the night. I have to be out of there from 9am to 5pm though because they spray everything down daily (which is smart, I haven't seen a single bedbug). And I can still get meals -- I asked for a bag lunch and they said just eat in the cafeteria but wear a mask while not eating -- so there's, uh, that? I guess. Jesus, the covid response in this country is *so bad*.

Also, between buying tissues (the kind with aloe, because my poor nose), cough drops (they're not actually doing much but they get the coughing down from like... "surprised I'm not literally coughing up parts of my respiratory system" levels), food last night because the ER doesn't serve dinner, and so forth, I'm flat broke. Of fucking course.

(I also managed to forget my big box of KN94s down at my partner's place, and I can't receive packages or "large envelopes" here. So I'm getting by with crappy Walmart masks and the slightly better one I begged from the ER nurse. We're arranging to get me some proper N95s or equivalent through a friend's address, but obviously that's gonna take a bit.)

One thing I *can* hypothetically do, or would like to, is not take transit while I'm actively contagious. Which means I need gas money. And parking money -- I had to pay $6 for parking just to sit at the hospital for five hours and find out I had Covid, and that was the discount rate. Parking prices around here are outrageous. (I've been, uh, just not paying the meters around the shelter, and I haven't gotten towed yet, but most other places require payment.)

Uh. Where was I? (Very brain-foggy, is where. I keep having to go back and edit in things I forgot to say.) Right. So if anybody would like to chip in on "help JT not infect any *more* people than necessary", my PayPal is ethanrabbits at gmail or my Ko-fi is here.

God, everything happens so much. (Also, I appreciate y'all's good wishes.)

[nightingalesandnorco]

Can you say more about the cardiac injuries from your flail chest post? Contusion, tappenade. What are these like and how are they treated, and if someone has these on top of other injuries, what happens?

I got you! I wrote that post after a 10-hour hospital shift followed by an 8-hour school day so I just wanted to finish it and go to bed, but I'm rested now so let's get into it!

Pulmonary contusion: This is a bruised lung but can be mild or severe. If mild, it may have no immediate symptoms, but a severe pulmonary contusion can present with chest pain, difficulty breathing, coughing up blood-tinged sputum, and possible respiratory distress (fast breathing, wheezing, fast heartbeat, using chest muscles to breathe, pallor) or failure (normal or slow breathing, low blood pressure, slow heartbeat, lethargy, confusion, blue-tinged skin). Symptoms can present up to 24 to 48 hours after the injury in mild cases but can appear within hours in severe cases. When combined with other lung injuries, pulmonary contusion may require CPAP/BiPAP or ventilation. The patient will also receive pain medication and diuretics (medications that increase urine output) to reduce excess fluid in the lungs.

Myocardial contusion: This is a bruise on the heart muscle. Since the cells in the heart muscle don't regenerate like other body cells, myocardial contusions can lead to death of parts of the muscle and produce a syndrome similar to a heart attack. A patient will likely present with chest pain, shortness of breath, dizziness, stomach discomfort, low blood pressure, fast heart beat, palpitations, and distended neck veins. Myocardial contusions are treated with oxygen; IV fluids; and medications to raise the blood pressure, lower the heart rate, and control pain. Severe cases may be treated with cardiac bypass surgery or heart valve replacement.

Diaphragmatic injury/rupture: This is a tear in the diaphragm, the muscle under the lungs that causes them to inflate and deflate. This presents with respiratory distress. A herniation of the intestines into the chest can also occur, which can lead to loss of blood flow to and death of that section of intestine if left untreated. Diaphragmatic injury/rupture requires surgical repair, and the patient will have a chest tube (shown below) for a few days postoperatively.

Injury to the great vessels: The great vessels are the aorta and vena cava and injuries to them include tears/ruptures and aortic pseudoaneurysms, which may rupture. These are often asymptomatic until internal bleeding is substantial, in which case the patient will present with pallor, low blood pressure, and dizziness. A ruptured aortic aneurysm will present will tearing abdominal pain. These injuries are treated with surgical repair, blood transfusions, or endovascular repair (minimally invasive).

Tension pneumothorax/hemothorax/punctured lung: A tension pneumothorax occurs when a tear or puncture in the lung or pleural sac (membrane that surrounds the lung) allows air into the pleural space (between the lung and pleural sac) and compresses the lung. A hemothorax occurs when blood fills the pleural space and compresses the lung. These might sometimes be called "sucking chest wounds." Tension pneumothorax/hemothorax presents with respiratory distress or failure, asymmetric chest shape and expansion, the trachea being off-center in the throat, fast heart beat, low blood pressure, and distended neck veins. This is initially treated with needle decompression, in which a needle is used to puncture the pleural sac to let air or blood out, followed by insertion of a chest tube. If there are two simultaneous pneumothoraces/hemothoraces, surgery is indicated.

Cardiac tamponade [tam-po-NOD]: This like a hemothorax but in the sac that surrounds the heart (pericardial sac), and can present with chest pain, palpitations, and shortness of breath. Severe cases can present with dizziness, syncope, and confusion or lethargy. Cardiac tamponade is treated with pericardiocentesis, which is a needle inserted into the pericardial sac to drain the accumulated fluid. If this doesn't work, the sac is drained surgically.

Clavicular fracture: This is a fractured collar bone and presents like any fracture, with pain and swelling. In this case, the arm on the affected side will be displaced downward slightly. These are treated with immobilization with a sling for 6-12 weeks. If the bone protrudes through the skin or multiple displaced fractures are present, surgery is indicated.

Sternal fracture: This is a fracture of the sternum, or breast bone. These present with chest pain, pain with deep breathing and coughing, and swelling. Surgery is not required unless there are displaced or unstable fractures. Deep breathing exercises with pain management are encouraged.

Happy whumping!