Date Published

July 23, 2015

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: A patient is presenting with pulmonary edema. Patient became more symptomatic before calling and dyspnea worsened. Upon gathering history and taking vitals, they meet the criteria for Nitro and CPAP. The patient is currently prescribed Lasix for fluid in the lungs from doctor visit one week ago.

With the history of pulmonary edema and being prescribed Lasix for fluid in the lungs, would this now be considered Non-Acute Pulmonary Edema?

I need a better understanding of Acute Pulmonary Edema vs. Non-Acute Pulmonary Edema. The CPAP protocol indication lists: Suspected Acute Pulmonary Edema.

Since the pulmonary edema is non-acute would CPAP and Nitro be withheld? Or, since the symptoms have worsened, provided I can recognize a patient that is truly in need of CPAP and Nitro, would I administer them? I want to clarify - thanks.


Thanks for the question.  The intent of the medical directive was for a patient who has an acute exacerbation of pulmonary edema which is the etiology of their shortness of breath or respiratory distress prompting the 911 response.  In other words, many patients as you nicely outline have underlying congestive heart failure with poor left ventricular function.  It is most likely these patients have some underlying mild pulmonary edema daily for which their primary care physician has prescribed them a host of medications (such as Lasix or an Ace Inhibitor etc.).  These patients however are generally well controlled until they have an acute worsening of their pulmonary edema which is manifested by respiratory distress.  This can occur suddenly, or over the course of days.  The causes for these acute exacerbations can by multiple (new onset atrial fib with loss of atrial kick, cardiac ischemia, acute MI, increased fluid intake, medication non-compliance, etc.).  Therefore, yes patients can have longstanding pre-existing pulmonary edema, but the medical directive is designed for a patient who is acutely short of breath or in respiratory distress and the underlying cause of this is judged by the paramedic to be related to pulmonary edema.  The patient you describe above fits this category and therefore should be treated as you describe. We hope this helps to clarify!



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