Acute Cardiogenic Pulmonary Edema Medical Directive

Question 1

Acute Cardiogenic Pulmonary Edema Medical Directive

Answer 1

A Primary Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Question 2

Indications

Answer 2

Moderate to severe respiratory distress;
AND
Suspected acute cardiogenic pulmonary edema.

Question 3

Conditions - Nitroglycerin

Answer 3

Age: ≥ 18 years
LOA: N/A
HR: 60-159 bpm
RR: N/A
SBP: Normotension
Other: N/A

Question 4

Contraindications - Nitroglycerin

Answer 4

• Allergy or sensitivity to nitrates
• Phosphodiesterase inhibitor use within the previous 48 hours
• SBP drops by one-third or more of its initial value after nitroglycerin is administered

Question 5

Treatment

Answer 5

• Consider nitroglycerin.

- Consider 12-lead ECG acquisition and interpretation.

Question 6

Consider nitroglycerin

Answer 6

SBP ≥ 100 mmHg to < 140 mmHg with IV or Hx*:
Route: SL
Dose: 0.3 mg or 0.4 mg
Max. single dose: 0.4 mg
Dosing interval: 5 min
Max. # of doses: 6

SBP ≥ 140 mmHg without IV or Hx*:
Route: SL
Dose: 0.3 mg or 0.4 mg
Max. single dose: 0.4 mg
Dosing interval: 5 min
Max. # of doses: 6

SBP ≥ 140 mmHg with IV or Hx*:
Route: SL
Dose: 0.6 mg or 0.8 mg
Max. single dose: 0.8 mg
Dosing interval: 5 min
Max. # of doses: 6

*Hx refers to a patient with a prior history of nitroglycerin use

Question 7

Clinical Considerations

Answer 7

IV condition applies only to PCPs authorized for PCP Autonomous IV.