Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/37 PASS/FAIL (Circle One)

Points Possible Points Awarded
Prepares patient              
    Takes or verbalizes appropriate PPE precautions            1
    Assures adequate blood pressure            1
    Positions patient in a position that will optimize ease of ventilation (high Fowler’s)            1
Assesses patient to identify indications for CPAP          
    Congestive heart failure, COPD,  asthma, pneumonia, pulmonary edema, near drowning            6
Assesses patient to identify absolute contraindications for CPAP          
Unconscious/unresponsive, inability to protect airway or inability to speak, inability to sit up, respiratory arrest/agonal respirations, nausea/vomiting, hypotension (systolic blood pressure <90mmHg), suspected pneumothorax, cardiogenic shock, penetrating chest trauma, facial anomalies/trauma/burns, closed head injury, active upper GI bleeding or history of recent gastric surgery (1 pt for each assessed)           12
Relative contraindications              
         History of pulmonary fibrosis            1
         Decreased LOC            1
         Claustrophobia or unable to tolerate mask (after first 1-2 minute trial)            1
Selects, checks, assembles equipment          
    Assembles mask and tubing according to manufacturer instructions            1
    Connects CPAP unit to suitable O2 supply/ensures oxygen is flowing            1
Performs procedure          
    Places mask over mouth and nose (leaves EtCO2 nasal cannula in place)            1
    Titrates CPAP pressure (based on local protocols/device dependent)            1
    Coaches patient to breathe normally and adjust to air pressure            1
Frequently reassesses patient for desired effects/goals of CPAP          
Decreased or elimination of dyspnea, decreased respiratory rate, decreased heart rate, SpO2 >92%, stabilized blood pressure, absence of complications e.g. barotrauma and pneumothorax (1 pt for each assessed)            5
In the event of Failure to Improve:          
Should patient fail to show improvement with CPAP, asw indicated by sustained or increased heart rate, Respiratory rate or blood pressure or by a decrease in level of consciousness remove CPAP device and assist ventilations with BVM or ETI as needed            3

                                        Points Possible: 37 Total Points Awarded_______________

Critical Criteria

●      Failure to list 10 of the 15 absolute/relative contraindications

●      Failure to list desired effects/Goals of CPAP

●      Failure to identify potential complications (Barotrauma, Pneumothorax)

●      Failure to properly assemble the device

●      Failure to frequently reassess the patient after application of the CPAP device

FA info icon.svg Angle down icon.svg Page data
SDG SDG03 Good health and well-being
Authors Catherine Mohr
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 1 pages link here
Impact 393 page views
Created November 22, 2021 by Catherine Mohr
Modified March 1, 2023 by Felipe Schenone
Cookies help us deliver our services. By using our services, you agree to our use of cookies.