Cardiogenic Pulmonary Edema - Cardiac (non-arrest)

Question 1

What is the cardiogenic pulmonary edema algorithm for a pt in mild/moderate distress (MAP >70, normal LOC, crackles/wheezes, mild hypoxemia)?

Answer 1

1. 12-lead, high fowlers, consider BiPap
2. Nitroglycerine SL q5 min PRN
3. Patch: Furosemide 40mg IV/IO (or double pt’s usual dose)
4. Continue treatment until TOC complete

Question 2

What is the cardiogenic pulmonary edema algorithm for a pt in severe distress (MAP >70, marked respiratory distress, severe hypoxemia BUT NO SIGNS OF SHOCK)?

Answer 2

1. 12-lead, high fowlers, consider BiPap
2. Nitroglycerine SL q5 PRN
3. Initiate NIPPV directive then patch
4. Nitroglycerin IV/IO
5. Furosemide 40mg IV/IO
6. Consider treating concurrently with Universal Airway Algorithm

Question 3

What is the cardiogenic pulmonary edema algorithm for a pt in severe distress and cardiogenic shock (MAP <65, altered LOC, pale/cool/diaphoretic, lactic acidosis)?

Answer 3

1. 12-lead, high fowlers, consider BiPap
2. Prepare for advanced airway management
3. Consider vasopressors to resuscitate prior to intubation
4. Treat concurrently with Universal Airway and Cardiogenic Shock medical directives
   Note: avoid nitro, furosemide, morphine, propofol, midazolam and lorazepam in pulmonary edema with shock