Adult Pulmonary Edema

Question 1

Adult Pulmonary Edema - BP > 100 mmHg Tx?

Answer 1

Nitro 0.4 mg SL to total max of 2 mg

CPAP

Question 2

Adult Pulmonary Edema - BP < 100 mmHg Tx?

Answer 2

Mandatory OLMC
Norephinephrine 0.1-0.3 mcg/kg/min
CPAP or airway management

Question 3

Adult Pulmonary Edema - BP > 100 mmHg transport time < 30 min?

Answer 3

Nitro 0.4 mg SL q 5 to total max of 2 mg

Question 4

Adult Pulmonary Edema - BP > 100 mmHg transport time > 30 min?

Answer 4

Nitro infusion 20-200 mcg/min

Question 5

Adult Pulmonary Edema - BP > 100 mmHg transport time > 30 min refractory to medications consider?

Answer 5

Intubation with PEEP 5 cmH2O increase by 2.5, max of 10 cmH2O

Question 6

Adult Pulmonary Edema - S/S of impending respiratory failure?

Answer 6

SpO2 less than 85%
EtCO2 greater than 50 mmHg
Accessory muscle use
Altered level of consciousness

Question 7

Adult Pulmonary Edema - nitroglycerin indications?

Answer 7

Pulmonary edema

Question 8

Adult Pulmonary Edema - nitroglycerin dose?

Answer 8

0.4 mg SL q 5 min to a total max of 2 mg

Question 9

Adult Pulmonary Edema - nitroglycerin contraindications?

Answer 9

Systolic BP less than 100 mmHg
Right ventricular infarcts
Patient taking phosphodiesterase inhibitors

Question 10

Adult Pulmonary Edema - nitroglycerin precautions? (3)

Answer 10

Single most effective agent for the treatment of acute pulmonary edema
Must be maximized in all patients who have a systolic BP greater than 100 mmHg
Remove patch if patient develops hypotension or adverse effects

Question 11

Adult Pulmonary Edema - norepinephrine indications?

Answer 11

Shock with hypotension refractory to fluid resuscitation

Question 12

Adult Pulmonary Edema - norepinephrine dose?

Answer 12

Mandatory OLMC

Start at 0.1 mcg/kg/min to max 0.3 mcg/kg/min

Question 13

Adult Pulmonary Edema - norepinephrine contraindications?

Answer 13

Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia

Question 14

Adult Pulmonary Edema - norepinephrine precautions?

Answer 14

Administering into a large vein reduces the risk of extravasation

Question 15

Adult Pulmonary Edema - norepinephrine administration?

Answer 15

Draw 4 mL off from a 250 mL bag of D5W or NS
Add 4 mg (1mg/mL) norepinephrine = 16 mcg/mL
Use the Drip Rate Flow Controller with a 60 drop set

Question 16

Adult Pulmonary Edema - nitroglycerin infusion dose?

Answer 16

start at 20 mcg/min, increase by 10 mcg/min q 5 min to a max of 200 mcg/min

Question 17

Adult Pulmonary Edema - nitroglycerin patch dose?

Answer 17

0.8 mg/hr

Question 18

Adult Pulmonary Edema - pt wearing personal nitro patch and requires EMS nitro?

Answer 18

Remove patients nitro patch

Question 19

Adult Pulmonary Edema - PEEP precautions

Answer 19

BP needs to be > 90

Contraindicated in pt with pneumothorax