Acute Cardiogenic Pulmonary Edema- MD

Question 1

What are the indications?

Answer 1

Moderate - severe respiratory distress AND suspected acute cardiogenic pulmonary edema

Question 2

What are the conditions for NITRO?

Answer 2

> = 18 y/o
HR= 60-159bpm
- NORMOtension

Question 3

What are the contraindications for NITRO?

Answer 3

ax or sensitivity to nitro

phosphodiester (VIAGARA) use in last 48 hours

if BP tanks 1/3 of the original BP after one dose

Question 4

What are signs and symptoms of ACPE?

Answer 4

CRACKLES!!! - AUSCULTATE

Possible new onset of CHF (hx of HTN, heart problems, one sided HF)

Cannot sleep laying down!!

Question 5

Does your patient have to be FULLY alert to give them NITRO under this directive?

Answer 5

technically no lol (LOA- N/A in conditions)

Question 6

What is the treatment for NITRO if SBP is >=100mmHg - <140mmHg? (with a hx of nitro use or IV access)

Answer 6

Hx or IV- YES
SL
0.3 or 0.4mg
max single does -0.4mg
dosing interval- 5 mins
max # of doses - 6 !!!

Question 7

What is the treatment for NITRO if SBP is >=140mmHg? (with NO hx of nitro use or IV access)

Answer 7

Hx or IV- NO!!!!
SL
0.3 or 0.4mg
max single does -0.4mg
dosing interval- 5 mins
max # of doses - 6 !!!

Question 8

What is the treatment for NITRO if SBP is >=140mmHg? (with a hx of nitro use or IV access)

Answer 8

Hx or IV- YES!!!!
SL
0.6 or 0.8mg
max single does -0.8mg
dosing interval- 5 mins
max # of doses - 6 !!!

Question 9

If patients vital signs fall OUT of parameters at anytime during the call (ex. hypotension) the pt can NO longer receive that medication - NITRO even if the pt’s vitals return to normal, why??

Answer 9

because there is bigger risk of recurrent decompensation!!

Question 10

Nitro is a symptom relief medication that has not demonstrated changes in a patients morbidity or mortality and should be used with caution in patients presenting with _____ or SBP close to _____ !!

Answer 10

TACHYCARDIA

SBP around 100!!!

higher chance of tanking!!

Question 11

If a patient is experiencing pulmonary edema AND ischemic chest pain… how should we treat according to the ALS?

Answer 11

max dose is either 0.4 or 0.8

so chose ONE directive to go under but remember you can also use CPAP to push fluid out if pulmonary edema exists alongside a STEMI!!! (STEMI you can only give 3 sprays of nitro)

Question 12

Is a 12 lead required for administration of NITRO in this directive?

Answer 12

NOPE

However, it is advised to get one as soon as possible or when practical to do so

Question 13

If the administration of NITRO results in hypotension in a patient and a PCP is AIV what do we do?

Answer 13

Fluid bolus is permitted despite the presence of crackles! Once the patient is normotensive, discontinue the fluid bolus and withhold any more medication.