Acute Cardiogenic Pulmonary Edema Medical Directive

Question 1

What are the indications?

Answer 1

• Moderate to severe respiratory distress; AND suspected acute cardiogenic pulmonary edema

Question 2

What medications are given?

Answer 2

• Nitroglycerin

Question 3

What are the conditions for Nitroglycerin?

Answer 3

• Age= >18 yrs
• HR= 60-159bpm
• SBP= normotension

Question 4

What are the contraindications for Nitro?

Answer 4

• Allergy or sensitivity to nitrates
• Phosphodiesterase inhibitor use within the previous 48 hrs
• SBP drops by 1/3 or more of its initial value after nitro is administered

Question 5

What is the treatment for nitroglycerin? (SBP= >100 mmHg to <140 mmHg, IV or Hx= Yes)

Answer 5

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

Question 6

What is the treatment for nitroglycerin? (SBP >140 mmHg & No IV or Hx)

Answer 6

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

Question 7

What is the treatment for nitroglycerin? (SBP >140 mmHg & Yes IV or Hx)

Answer 7

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

Question 8

What does the Hx for TX refer to?

Answer 8

Hx refers to a pt with a prior history of nitroglycerin use

Question 9

What are the clinical considerations?

Answer 9

• IV condition applies to PCPs authorized for PCP Autonomus IV