Category Archives: Acute Cardiogenic Pulmonary Edema

Category: Acute Cardiogenic Pulmonary Edema, Bronchoconstriction   |   Date:

What is the SWORBHP stance on administering salbutamol in patients with suspected ACPE? Most of us have been traditionally taught that salbutamol in patients presenting with crackles due to suspected ACPE is a negative thing because of the bronchodilation and the risk of “flooding” a patient. However, there are many studies that argue salbutamol administration could be beneficial. Especially in situations where patients are presenting with both wheezes and crackles, it can get confusing. Where does SWORBHP stand on this topic?

Category: Acute Cardiogenic Pulmonary Edema, CPAP   |   Date:

Does cpap have to be used with nitro

Category: Acute Cardiogenic Pulmonary Edema, Cardiac Ischemia   |   Date:

If a patient is given first time Nitro by a PCP IV but then isn’t ever actually prescribed nitro by a doctor does this count as prior hx of nitro use? Could a then PCP non IV give this pt nitro the next time they call?

Category: Acute Cardiogenic Pulmonary Edema   |   Date:

Question: How can someone differentiate between crackles found in Acute Cardiogenic Pulmonary Edema between those found in pneumonia?

Category: Acute Cardiogenic Pulmonary Edema   |   Date:

Question: A patient is presenting with pulmonary edema. Patient became more symptomatic before calling and dyspnea worsened. Upon gathering history and taking vitals, they meet the criteria for Nitro and CPAP. The patient is currently prescribed Lasix for fluid in the lungs from doctor visit one week ago.

With the history of pulmonary edema and being prescribed Lasix for fluid in the lungs, would this now be considered Non-Acute Pulmonary Edema?

I need a better understanding of Acute Pulmonary Edema vs. Non-Acute Pulmonary Edema. The CPAP protocol indication lists: Suspected Acute Pulmonary Edema.

Since the pulmonary edema is non-acute would CPAP and Nitro be withheld? Or, since the symptoms have worsened, provided I can recognize a patient that is truly in need of CPAP and Nitro, would I administer them? I want to clarify - thanks.

Category: Acute Cardiogenic Pulmonary Edema, CPAP   |   Date:

Question: I have been talking with my paramedic colleagues and I am wondering about the role of CPAP and aspiration. My understanding of the Medical Directive is that CPAP is not indicated for pneumonia or aspiration but rather severe SOB from either COPD or pulmonary edema. Can you please clarify the role of CPAP for respiratory distress patients with either pneumonia or aspiration as the underlying precipitating factor for their SOB?

Category: Acute Cardiogenic Pulmonary Edema   |   Date:

Question: I have a question regarding congestive heart failure (CHF) and ASA. If a patient is having acute CHF and is coughing up blood but is also having chest pain are they still a candidate to receive ASA given the active "bleeding". I would think the blood from back up into your lungs is different than the blood from an ulcer or something. Thanks for your help.

Category: Acute Cardiogenic Pulmonary Edema   |   Date:

Question: Last night I had a 75 year old patient calling because he was SOB x 2 days with it worsening this evening. Patient could not sleep (could not breathe very well laying down) and was more SOB on exertion. I could hear fine crackles in the bases of his lungs.

There was no ischemic chest pain or NTG history. His vitals on contact were HR 90, BP 188/70 (ish), SPO2 95% on Room air, 100% on NRB, RR 24 verified with an with ETCO2 of 40mmHg, No ST changes in 12 lead.

He had some slight increased work of breathing on scene with mild increased diaphragmatic use but was speaking full sentences and in good spirits with us. Patient had a history of COPD and CHF. He also stated he had taken some of his Ventolin puffers prior to our arrival with no relief (probably made things worse). I wanted to treat him with NTG but he did not seem to be in enough distress initially, so I kept him on the NRB which he stated help initially. We got to the truck and started an IV enroute, then administered 0.8mg NTG. Literally... within about 2 minutes of the NTG admin, while I was patching, the patient had a sudden onset of severe SOB. We were right outside the hospital, so I grabbed my BVM, assisted his respirations distress until my partner could get us out of the truck and help me put CPAP on. CPAP helped and he was back to normal shortly after our transfer of care.

My question is, should I have used the CPAP right away with the NTG, even though the patient was not showing signs of severe respiratory distress at the time, and on numerous auscultations of the lung, did not have any increase in crackles... until of course, he developed that sudden severe respiratory distress? My gut was to CPAP him early, but I felt he did not fit the protocol yet given his level of dyspnea, SPO2 sats, RR and minimal accessory muscle use.

Category: Acute Cardiogenic Pulmonary Edema, Cardiac Ischemia   |   Date:

Question: A nitro virgin patient presenting with chest pain attends a doctor's office. Doctor administers 1 spray of nitro prior to EMS arrival. Upon assessment by EMS, patient still presents with chest pain. Is the patient still considered a virgin nitro patient as this is the first incident he/she has had with nitro? Or since the doctor administered a spray, does that count as a previous use of nitro?

Category: Acute Cardiogenic Pulmonary Edema, CPAP   |   Date:

Question: We are instructed to get the nitro in, if applicable, apply the CPAP and if there is improvement, do not remove the mask for additional nitro sprays. Is the improvement slight or significant? If slight improvement, do we leave the pressure at the slight improvement pressure or titrate 2.5cmH2O?

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