Acute Cardiogenic Pulmonary Edema Medical Directive

Question 1

ACPE

What are the indications for the Acute Cardiogenic Pulmonary Edema Medical Directive?

Answer 1

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

Question 2

ACPE

What are the conditions for nitroglycerin?

Answer 2

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

Question 3

ACPE

What are the contraindications for nitro use?

Answer 3

• 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 4

ACPE

What is the order of treatment for the ACPE MD?

Answer 4

1. Consider nitroglycerin
2. Consider 12-lead ECG acquisition and interpretation

Question 5

ACPE

What is the nitro dose for patients whose SBP is ≥100 mmHg to
<140 mmHg?

Answer 5

Must have 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

Question 6

ACPE

What is the nitro dose for patients who have a SBP of ≥140mmHg and no IV or Hx?

Answer 6

Route SL
Dose: 0.3 mg or 0.4 mg
Max. single dose: 0.4 mg
Dosing interval: 5 min
Max. # of doses: 6

Question 7

ACPE

What is the nitro dose for patients who have a SBP of ≥140mmHg with IV or Hx?

Answer 7

Route SL
Dose: 0.6 mg or 0.8 mg
Max. single dose: 0.8 mg
Dosing interval: 5 min
Max. # of doses: 6

Question 8

ACPE

What are the clinical considerations?

Answer 8

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