Acute Cardiogenic Pulmonary Edema Medical Directive

Question 1

ACPE MD

What are the indications for the ACPE MD?

Answer 1

Moderate to severe respiratory distress;
AND
Suspected acute cardiogenic pulmonary edema.

Question 2

ACPE MD

What are the conditions for nitro administration?

Answer 2

Age: ≥18 years
HR: 60-159 bpm
SBP: Normotension

Question 3

ACPE MD

What are the contraindications for nitro administration?

Answer 3

Allergy or sensitivity to nitrates.
Phosphodiesterase inhibitor use within the previous 48 hours.
SBP drops by one-third or more of its initial value after nitroglycerin is administered.

Question 4

ACPE MD

What is the dosing for nitro with SBP ≥100 mmHg to <140 mmHg?

Answer 4

IV or Hx: Yes.
Route: SL
Dose: 0.3 or 0.4 mg
Dosing interval: 5 min
Max # of doses: 6

Question 5

ACPE MD

What is the dosing for nitro with SBP ≥140 mmHg without IV or Hx?

Answer 5

Route: SL
Dose: 0.3 mg or 0.4 mg
Dosing interval: 5 min
Max # of doses: 6

Question 6

ACPE MD

What is the dosing for nitro with SBP ≥140 mmHg with IV or Hx?

Answer 6

Route: SL
Dose: 0.6 mg or 0.8 mg
Dosing interval: 5 min
Max # of doses: 6