Acute Cardiogenic Pulmonary Edema Pneumonia

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.