Question: I had a question in regards to why do we need to establish an IV in a patient with suspected pulmonary edema? If they fit this protocol, they will most likely have crackles, and therefore if we happen to bottom out their pressure with nitro sprays, we will not be able to bolus due to the patient having crackles. Thanks in advance.

Great question! Bottom line- you are right- it does not make sense having an IV established as a PCP for a patient with pulmonary edema to enable a possible fluid bolus in the event of nitroglycerin induced hypotension. The crackles would be a contra-indication. This idiosyncrasy has managed to make it through the editing process and has been noted for future editions. An ACP would have the ability to administer dopamine through this IV. Until a future edition is released however, we must follow the current directives

Acute Cardiogenic Pulmonary Edema,Cardiac/Circulation,Intravenous and Fluid Therapy

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