Intervention Guideline:
Pulmonary Edema / CHF
Indications:
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Short of breath patients with pulmonary edema secondary to acute congestive heart failure
These guidelines assume that all interventions are:
 Based on the relevant medical principles document
 Delivered in the context of the universal fundamental approach for all patients
Responder
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FR
EMR
PCP
ACP
CCP
ACP
CCP
Hospital
Inter-Hospital (CCP)
Actions
Keep the patient at rest
Position the patient upright, with the legs dependent
Supplemental oxygen
IPPV as required
Correct rhythm disturbance
 Symptomatic Bradycardia
 Symptomatic Wide Complex Tachycardia
 Symptomatic Narrow Complex Tachycardia
Intubate as required
Treat hypertension:
 Nitroglycerin
Discuss case with EP for ancillary treatments.
Initiate diuresis
 Furosemide
Reduce pain and anxiety
 Morphine
Reduce airway pressure / Bronchodilate:
 Ventolin
 Atrovent
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Fibrinolytic therapy / PCI
CPAP – BiPAP
Mechanical ventilation
IV Nitroglycerin
Pressor agents – Dopamine or Dobutamine
Antiarrythmic therapy and rate control
Intra aortic balloon pump
Surgical intervention
Pulmonary edema with hypertension
0.4 mg SL as required
Known sensitivity to Nitroglycerin
Hypotension BP < 100 mmHg
Contraindications
Viagra or Levitra use in last 24 hours
Cialis use in last 48 hours
Indication
Dose/route
Pulmonary edema with hypertension
2.5 mg I.V. q 2-3 minutes to effect
Known sensitivity to morphine
Contraindications
Caution in COPD patients
Indication
Dose/route
Pulmonary edema with hypertension
Equivalent of patients RX or dose identified in consultation with EP
Allergy to furosemide, sulfonamides (cross-reaction)
Tartrazine (also know as Yellow Dye No. 5)
Hypotension
Contraindications
Pre-existing electrolyte depletion - in particular: hypokalemia, anuria, renal failure,
hepatic coma, pregnancy, lactation.
Use cautiously in the presence of diabetes mellitus
Indication
Dose/route
Bronchospasm
Indication
5 mg nebulized with 02
Dose/route
Contraindications Known sensitivity to Ventolin
Bronchospasm
0.5 mg with 5 mg Ventolin nebulized with 02
Known sensitivity to Atrovent
Contraindications
Patient has previously received dose
Indication
Dose/route