Pulmonary Edema and CHF

Question 1

Nitro

Answer 1

0.4mg SL Q5min X3

Question 2

IV Nitro if no improvement with SL

Answer 2

10 mcg/min IV, rapidly titrate q 3 – 5 min PRN. Max rate 400 mcg/min. Maintain SBP >90 mmHg.

Question 3

CPAP or BiPAP

Answer 3

Per protocol

Question 4

Lasix if BP >100

Answer 4

a. Adult: 20 mg or amount equal to patient’s usual oral dose, whichever is higher. Max dose 100 mg. Administer IV over 1 -2 minutes.
b. Pediatric: 1 – 2 mg/kg IVP up to 20 mg or amount equal to patient’s usual oral dose, whichever is higher.

Question 5

If Wheezing is present

Answer 5

Duoneb or albuterol

Question 6

Continued respiratory distress after initial treatments

Answer 6

High dose Nitroglycerina. SBP must be ≥ 120
b. Nitroglycerin 400 mcg IV over 2 minutes via infusion pump.
c. If continued respiratory distress after 5 minutes and SBP ≥ 120, may repeat
400 mcg infusion x 2.
d. If respiratory distress improves, start nitroglycerin infusion 100 mcg/min.

Question 7

If respiratory distress does not improve

Answer 7

Consider intubation