Acute Cardiogenic Pulmonary Edema + CPAP Flashcards

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1
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What are the INDICATIONS?

What are the signs AND symptoms of cardiogenic pulmonary edema or CHF?

A

Moderate to severe respiratory distress
AND
Suspected acute cardiogenic pulmonary edema

Peripheral edema/pitting edema - (right ventricular blood bluids up in the capillaries)

Diaphoretic

Pail

Bounding radial pulse

Rapid radial pulse

Crackles

Frothy pink sputum

1-2 word dyspnea

low cap refill

AND

Dyspnea

Anxious

Nauseous

Chest pressure

Needing to sitting up/can’t sleep lying down (sitting up sleeping)

Fatigued/lethargic

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2
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What are the CONDITIONS for Nitroglycerin?

What are the CONTRAINDICATIONS?

A

GREATER/EQUAL to 18 years old

LOA - N/A

60-159bpm

Normotension

Allergy or Sensitivity to nitrates

PDE-I use within the previous 48 hours

SBP drops by 1/3rd of the initial value after the administration of nitroglycerin

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3
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What is nitroglycerin?

What does it do?

Why is it LOA N/A not unaltered?

A

Vasodilator - relaxes blood vessels thus promoting blood flood

The pt will likely be hypoxic + panicking + therefore not GCS 15 (but it can’t say altered because there are patients that present unaltered as well)

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4
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What is a PDE-I and why does it matter with regards to nitro?

A

cAMP and cGMP cause smooth muscle relaxation. PDE5 inhibitors stop the degradation of cGMP causing an increase in cGMP - this increases sm relaxation in response to nitric oxide - this further reduces pulmonary vascular resistance.

Nitrates (like nitro) increase the amount of cGMP which in combonation with PDE5 inhibitors will likely cause severe hypotension (i.e. they have the same BP effect)

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5
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What is the ROUTE and TREATMENT PLAN for nitro for a patient with a SBP ≥ 100mmHg but <140mmHg

This is with IV or Hx of nitro use

A

SL

Dose - 0.3mg OR 0.4mg

Max. Single Dose - 0.4mg

Dosing Interval - 5min

Max # of Doses - 6

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6
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What is the ROUTE and TREATMENT PLAN for nitro for a patient with a SBP ≥ 140mmHg and they DO have either an IV or Hx of nitro use?

Why do you need to have IV or Hx of nitro do give a higher dose?

What is the ROUTE and TREATMENT PLAN for a patient with a SBP ≥ 140mmHg and they DON’T have either an IV or Hx of nitro use?

A

SL

Dose - 0.6mg OR 0.8mg

Max. Single Dose - 0.8mg

Dosing Interval - 5min

Max # of Doses - 6

Becasue with a SBP ≥140mmHg you can be more liberal with the dosages

SL

Dose - 0.3mg OR 0.4mg

Max. Single Dose - 0.4mg

Dosing Interval - 5min

Max # of Doses - 6

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7
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

What are the clinical considerations?

Hint: 12-lead and IV

A

Do a 12-lead ECG acquisition and interpretation

IV only applies to PCPs authorzied for PCP Autonomous IV

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8
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

How many doses of nitro should you give a patient you suspect to have both cardiac ischemia and cardiogenic pulmonary edema?

Do you need to do a 12-lead before giving nitro?

Can you give a fluid bolus for a hypotensive patient with crackles (after they’ve recieved nitro)? When should you discontinue both fluid and nitro?

A

Only 3 - Cardiac ischemia overrides acute cardiogenic pulmonary edema

No, but you should anyway

Yes
When the patient becomes normotensive

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9
Q

Acute Cardiogenic Pulmonary Edema Medical Directive

Why can you give fluid bolus for a hypotensive patient with crackles?

A

Beacuse a patient can withstand pulmonary edema but not a lack of perfusion to the vital organs

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10
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What are the INDICATIONS?

What S+S might you see to think ACUTE pulmonary edema OR COPD?

A

Severe respiratory distress
AND
Signs and symptoms of acute pulmonary edema or COPD

Persistant cough
Barrel chest
Hard to lie down

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11
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What are the CONDITIONS?

What is CPAP?

What are the CONTRAINDICATIONS?

A

≥ 18 years

Tachypnea

Normotension

SpO2 <90% or there’s accessory
muscle use

Continous Positive Airway Pressure - keeps the airways open - slepp apn

Asthma exacerbation

Suspected pneumothorax

Unprotected or unstable airway

Major trauma or burns to the head or torso

Tracheostomy

Inability to sit upright

Unable to cooperate

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12
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What is classified as tachypneac?

What is classified as normotension?

What does Accessory muscle use look like?

A

Greater/Equal to 28

SBP Greater/Equal to 100mmHg

Clavicle indrawing
Tracheal indrawing
Intercostal indrawing
Air hunger
Tripoding
Shrugging
Grunting

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13
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

Why would asthma exacerbation in adults be a contraindication to CPAP?

What does obtunded mean?

A

Because overpressurizing the bronchioles with CPAP creates turbulant air which in turn worsens the bronchospasms and histamine release.

The pt is unable to hold their airway open (unpromted)
* dead weight
* can’t protect their own airway
* too exhausted
* too altered

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14
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

How do you check for suspected pneumothorax?

What happens when CPAP and nitro are used in conjuction with each other?

What can you do for pts that have had CPAP before?

A

Auscultate - decreased breath sounds

CPAP causes presserized
Nitro causes leaky capilaries
= fast fluid shift

Start them at a higher (or their known) dose.

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15
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What is the TREATMENT plan?

A

Initial Setting - 5cm H20 Or equivalent flow rate of device as per BH direction

Titration increment - 2.5cm H20 Or equivalent flow rate of device as per BH direction

Titration interval - 5 min

Max. setting 15cm H20 Or equivalent flow rate of device as per BH
direction

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16
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What’s the TREATMENT plan for considering increasing FiO2 (if available)?

Thier Fraction of inspired Oxygen

A

Initial FiO2 - 50-100%

FiO2 increment (if
available on device - SpO2 <92% despite treatment and/or 10cm

H2O pressure or equivalent flow rate of device as per BH direction

Max. - FiO2 100%

17
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

What do you do if you need to give medication while the patient has CPAP?

A

You can briefly interupt it to provide the medication when necessary.

18
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

Why is it important to monitor vitals during CPAP?

A

The positive pressure in the thorax may impede ventricular filling, resulting in
decreased preload.

Patients should be continuously monitored for signs of hypo-perfusion

19
Q

Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary

Can you consider CPAP as an additive therapy to any standards?

A

Yes, the bronchoconstriction or acute cardiogenic pulmonary edema BUT not as a replacement

20
Q

Phosphodiesterase (PDE) 5 inhibitor list?

16

what are many known as?

A
  • Viagra
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  • Sildenafil
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  • Udenafil
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  • Lodenafil
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  • Acetildenafil
  • Aildenafil
  • Benzamidenafil,
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  • Icariin (a natural product)

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