RESPIRATORY DISTRESS PULMONARY EDEMA/CHF
ALL LEVELS
DESIGNATION OF CONDITION
Patient presenting with signs, symptoms, and history of moderate to severe dyspnea and or poor perfusion secondary to pulmonary edema. Emphasis will be placed on complete assessment of patient and history with treatment of the underlying cause if possible. Caution should be taken in getting a complete history since many of these patients are taking numerous medications for chronic conditions.
EMPHASIS ON PATIENT CARE
1. Primary Management - Assess ABC’s and manage as indicated.
2. CPAP should be initiated if patient able to tolerate mask and pressure.
3. Titrate oxygen to SpO2 >94%
4. SpO2 and ETCO2 monitoring
5. Initiate transport to an appropriate medical facility.
6. Secondary Management - History, physical exam, vital signs
AEMT
1. In-route, initiate an IV/IO of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.
2. Closely monitor IV drip rate. Do not overhydrate the patient.
3. Consider CPAP early.
PARAMEDIC
1. 12 lead EKG
2. Evaluate dysrhythmias and treat per appropriate guidelines.
a. May consider MIDAZOLAM 2 mg IV/IN for anxiolysis for CPAP administration.
3. Consider NITROGLYCERIN [0.4mg] SL every 5 minutes, if patient is in severe distress, and BP >100 systolic, HR > 60. Must have IV/IO initiated.
4. Consider FUROSEMIDE (Lasix) Only for use in patients that have Furosemide prescribed for them. Dose is two times their prescribed amount. For example, if the patient takes 20 mg. daily administer 40 mg. IV. Maximum dose is 100 mg. IV. Check vial concentration; the concentration is usually 10 mg./ml
ALL LEVELS
DESIGNATION OF CONDITION
Patient presenting with signs, symptoms, and history of moderate to severe dyspnea and or poor perfusion secondary to pulmonary edema. Emphasis will be placed on complete assessment of patient and history with treatment of the underlying cause if possible. Caution should be taken in getting a complete history since many of these patients are taking numerous medications for chronic conditions.
EMPHASIS ON PATIENT CARE
1. Primary Management - Assess ABC’s and manage as indicated.
2. CPAP should be initiated if patient able to tolerate mask and pressure.
3. Titrate oxygen to SpO2 >94%
4. SpO2 and ETCO2 monitoring
5. Initiate transport to an appropriate medical facility.
6. Secondary Management - History, physical exam, vital signs
AEMT
1. In-route, initiate an IV/IO of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.
2. Closely monitor IV drip rate. Do not overhydrate the patient.
3. Consider CPAP early.
PARAMEDIC
1. 12 lead EKG
2. Evaluate dysrhythmias and treat per appropriate guidelines.
a. May consider MIDAZOLAM 2 mg IV/IN for anxiolysis for CPAP administration.
3. Consider NITROGLYCERIN [0.4mg] SL every 5 minutes, if patient is in severe distress, and BP >100 systolic, HR > 60. Must have IV/IO initiated.
4. Consider FUROSEMIDE (Lasix) Only for use in patients that have Furosemide prescribed for them. Dose is two times their prescribed amount. For example, if the patient takes 20 mg. daily administer 40 mg. IV. Maximum dose is 100 mg. IV. Check vial concentration; the concentration is usually 10 mg./ml