ALS PCS: Acute Cardiogenic Pulmonary Edema Medical Directive

Question 1

Indications

Answer 1

Moderate to severe respiratory distress

AND

Suspected acute cardiogenic pulmonary edema.

Question 2

Conditions for Tx with NTG

Answer 2

≥18
60 ≤ HR < 160
SBP ≥ 100mmHg (Normotension)

Question 3

Contraindication for Tx with NTG

Answer 3

Allergy or sensitivity to nitrates.

PDE5 use in the past 48 hours.

SBP drops by 1/3 or more of its initial value after NTG administration.

Question 4

Treatment with NTG
100 ≤ SBP ≤ 140
Prior Use of NTG

Answer 4

Route: SL

Dose: 0.3 or 0.4mg

Max Single Dose: 0.4mg

Dosing Interval: 5mins

Max # of Doses: 6

Question 5

Treatment with NTG

SBP ≥ 140

NO Prior Use of NTG

Answer 5

Route: SL

Dose: 0.3 or 0.4mg

Max Single Dose: 0.4mg

Dosing Interval: 5mins

Max # of Doses: 6

Question 6

Treatment with NTG

SBP ≥ 140

Prior Use of NTG

Answer 6

Route: SL

Dose: 0.6 or 0.8mg

Max Single Dose: 0.8mg

Dosing Interval: 5mins

Max # of Doses: 6

Question 7

Clinical Considerations

Answer 7

N/A