Acute Cardiogenic Pulmonary Edema Pneumonia: Difference between revisions

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[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with [[Continuous Positive Airway Pressure Device|CPAP]] device in the patient with severe dyspnea.
[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with [[Continuous Positive Airway Pressure Device|CPAP]] device in the patient with severe dyspnea.




* If PULSE < 60 and systolic BP < 90 mm Hg, refer to [[Supraventricular Bradycardia and AV Blocks|SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS PRACTICE PARAMETERS]] (4.06).
* If PULSE < 60 and systolic BP < 90 mm Hg, refer to [[Supraventricular Bradycardia and AV Blocks|SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS PRACTICE PARAMETERS]] (4.06).
* If PULSE > 60 and systolic BP < 90 mm Hg, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
* If PULSE > 60 and systolic BP < 90 mm Hg, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
* If wheezing present, and pulse rate < 150 administer [[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft. Monitor heart rate and repeat as necessary or until HR> 150. [[Bronchodilators|IPRATROPIUM BROMIDE (ATROVENT)]] is contraindicated)
* If wheezing present, and pulse rate < 150 administer [[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft. Monitor heart rate and repeat as necessary or until HR> 150. [[Atrovent|IPRATROPIUM BROMIDE (ATROVENT)]] is contraindicated)
* If systolic BP > 110 mm Hg, and no presence of fever or other signs of pneumonia:
* If systolic BP > 110 mm Hg, and no presence of fever or other signs of pneumonia:
** [[Antianginals|NITROGLYCERIN]] 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until systolic BP < 110 mm Hg or [[Antianginals|NITROGLYCERIN DRIP]] established. (Team member shall be assigned as the “nitro-time keeper” and BP monitor)
** [[Nitro_Spray|NITROGLYCERIN SPRAY]] OR [[Nitro_Tablets|NITROGLYCERIN TABLET]] 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until systolic BP < 110 mm Hg or [[Nitro_Drip|NITROGLYCERIN DRIP]] established. (Team member shall be assigned as the “nitro-time keeper” and BP monitor)
**'''''Nitro is contraindicated if pt states use of Viagra, Levitra or Cialis (or any ED class of drugs) in the past 24-36 hours. (Document as a pertinent negative).'''''
**'''''Nitro is contraindicated if pt states use of Viagra, Levitra or Cialis (or any ED class of drugs) in the past 24-36 hours. (Document as a pertinent negative).'''''
* If systolic BP > 110 mm Hg, [[Antianginals|NITROGLYCERIN DRIP]] (25 mg in 500cc). Start at 5-15 mcg / minute via Infusion Regulator (“Dial a Flow” device) or Buretrol set. Increase by 5 mcg/min increments. Consider second IV of NaCl, however keep in mind the patient may be a candidate for Fibrinolytics. Monitor and document BP every 5 minutes.
* If systolic BP > 110 mm Hg, [[Nitro_Drip|NITROGLYCERIN DRIP]] (25 mg in 500cc). Start at 5-15 mcg / minute via Infusion Regulator (“Dial a Flow” device) or Buretrol set. Increase by 5 mcg/min increments. Consider second IV of NaCl, however keep in mind the patient may be a candidate for Fibrinolytics. Monitor and document BP every 5 minutes.
* If systolic BP > 90 mm Hg, [[Diuretics|FUROSEMIDE]] 1 mg / kg Slow IVP. (Maximum dosage is 100 mg)
* If systolic BP > 90 mm Hg, [[Lasix|FUROSEMIDE]] 1 mg / kg Slow IVP. (Maximum dosage is 100 mg)
**'''''NOTE: Furosemide should only be used, when you are sure the patient has CHF. Do not give a diuretic to a dehydrated patient. Check for edematous legs, jugular vein distention, ascites, sacral edema & rales.'''''
**'''''NOTE: Furosemide should only be used, when you are sure the patient has CHF. Do not give a diuretic to a dehydrated patient. Check for edematous legs, jugular vein distention, ascites, sacral edema & rales.'''''
* If systolic BP > 110mm HG and patient has not improved or the patient is anxious consider [[Morphine_Sulfate|MORPHINE SULFATE]] (2.04) refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PRACTICE PARAMETERS]] (2.04).
* If systolic BP > 110mm HG and patient has not improved or the patient is anxious consider [[Morphine_Sulfate|MORPHINE SULFATE]] (2.04) refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PRACTICE PARAMETERS]] (2.04).

Latest revision as of 14:32, 24 April 2020

Section 4 - CARDIAC

4.11 ACUTE CARDIOGENIC PULMONARY EDEMA

INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask or assist with CPAP device in the patient with severe dyspnea.


  • If PULSE < 60 and systolic BP < 90 mm Hg, refer to SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS PRACTICE PARAMETERS (4.06).
  • If PULSE > 60 and systolic BP < 90 mm Hg, refer to SHOCK PRACTICE PARAMETER (5.13).
  • If wheezing present, and pulse rate < 150 administer ALBUTEROL (PROVENTIL) 2.5 mg via updraft. Monitor heart rate and repeat as necessary or until HR> 150. IPRATROPIUM BROMIDE (ATROVENT) is contraindicated)
  • If systolic BP > 110 mm Hg, and no presence of fever or other signs of pneumonia:
    • NITROGLYCERIN SPRAY OR NITROGLYCERIN TABLET 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until systolic BP < 110 mm Hg or NITROGLYCERIN DRIP established. (Team member shall be assigned as the “nitro-time keeper” and BP monitor)
    • Nitro is contraindicated if pt states use of Viagra, Levitra or Cialis (or any ED class of drugs) in the past 24-36 hours. (Document as a pertinent negative).
  • If systolic BP > 110 mm Hg, NITROGLYCERIN DRIP (25 mg in 500cc). Start at 5-15 mcg / minute via Infusion Regulator (“Dial a Flow” device) or Buretrol set. Increase by 5 mcg/min increments. Consider second IV of NaCl, however keep in mind the patient may be a candidate for Fibrinolytics. Monitor and document BP every 5 minutes.
  • If systolic BP > 90 mm Hg, FUROSEMIDE 1 mg / kg Slow IVP. (Maximum dosage is 100 mg)
    • NOTE: Furosemide should only be used, when you are sure the patient has CHF. Do not give a diuretic to a dehydrated patient. Check for edematous legs, jugular vein distention, ascites, sacral edema & rales.
  • If systolic BP > 110mm HG and patient has not improved or the patient is anxious consider MORPHINE SULFATE (2.04) refer to ANALGESIA/SEDATION PRACTICE PARAMETERS (2.04).

Goal is for a B/P reduction to approximately 120/60 without an increase in pulse. This is for patients with no neurological involvement only.

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