Question: Why was Lasix removed from the pre-hospital CHF/Pulmonary Edema protocol, when the first thing an ER Physician orders on arrival at the ER is Lasix?
This has been a hotly debated issue among the various Regional Base Hospital Programs (RBH). Individual Medical Directors feel strongly about the use of Lasix for pulmonary edema both pro and con, however a consistent decision for Ontario needed to be made. On balance, there is a paucity of literature supporting the use of Lasix pre-hospital noted during multiple reviews of published evidence. There have been multiple cases of patients who had crackles noted on exam and Lasix administered then these patients were later diagnosed as having pneumonia with significant sepsis and dehydration. Given the lack of clear benefit, the small risk of possible harm for misdiagnosed patients, and the need to develop consistent directives, Lasix was removed from the directives.