Acute Cardiogenic Pulmonary Edema + CPAP Flashcards
Acute Cardiogenic Pulmonary Edema Medical Directive
What are the INDICATIONS?
What are the signs AND symptoms of cardiogenic pulmonary edema or CHF?
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
Acute Cardiogenic Pulmonary Edema Medical Directive
What are the CONDITIONS for Nitroglycerin?
What are the CONTRAINDICATIONS?
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
Acute Cardiogenic Pulmonary Edema Medical Directive
What is nitroglycerin?
What does it do?
Why is it LOA N/A not unaltered?
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)
Acute Cardiogenic Pulmonary Edema Medical Directive
What is a PDE-I and why does it matter with regards to nitro?
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)
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
SL
Dose - 0.3mg OR 0.4mg
Max. Single Dose - 0.4mg
Dosing Interval - 5min
Max # of Doses - 6
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?
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
Acute Cardiogenic Pulmonary Edema Medical Directive
What are the clinical considerations?
Hint: 12-lead and IV
Do a 12-lead ECG acquisition and interpretation
IV only applies to PCPs authorzied for PCP Autonomous IV
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?
Only 3 - Cardiac ischemia overrides acute cardiogenic pulmonary edema
No, but you should anyway
Yes
When the patient becomes normotensive
Acute Cardiogenic Pulmonary Edema Medical Directive
Why can you give fluid bolus for a hypotensive patient with crackles?
Beacuse a patient can withstand pulmonary edema but not a lack of perfusion to the vital organs
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?
Severe respiratory distress
AND
Signs and symptoms of acute pulmonary edema or COPD
Persistant cough
Barrel chest
Hard to lie down
Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary
What are the CONDITIONS?
What is CPAP?
What are the CONTRAINDICATIONS?
≥ 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
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?
Greater/Equal to 28
SBP Greater/Equal to 100mmHg
Clavicle indrawing
Tracheal indrawing
Intercostal indrawing
Air hunger
Tripoding
Shrugging
Grunting
Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary
Why would asthma exacerbation in adults be a contraindication to CPAP?
What does obtunded mean?
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
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?
Auscultate - decreased breath sounds
CPAP causes presserized
Nitro causes leaky capilaries
= fast fluid shift
Start them at a higher (or their known) dose.
Continuous Postive Airway Pressure (CPAP) Medical Directive - Auxilary
What is the TREATMENT plan?
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
