Question: I know there have been a lot of questions regarding the new cardiogenic pulmonary edema protocol. I am a student and just had a call regarding this. After the call there has been discussion about the directive and I have heard three different views and they are...

1. The first treatment column <140 you can ONLY give NTG if a IV is established (no hx.) 2. The second column stating that =>140 with no hx or Iv you can give 0.4mg is to be completely disregarded as it contraindicate the directives conditions 3. The third column stating that =>140 give 0.8mg ONLY if an IV is established (no hx.)

So the question I am asking is can you please clarify the treatment chart of the acute pulmonary edema directive?

 Thanks for the question. A similar question was asked and the answer posted in January. We hope this may assist you in interpreting the chart- it is confusing and will be changed when the directives are "re-opened" provincially for edits.

This is a frequently asked question and we have addressed this with the Province for a consistent change. Currently the interpretations of this directive vary both in the SWORBHP region and among other BH programs. The confusion surrounds the indications stating that in order to receive NTG, a patient must have either a history of use OR an IV established. Then, on the second page, the dosing listed on the "treatment" box states that if "no IV or Hx" and the BP is >140, then a single dose of NTG can be administered q5min with up to 6 doses maximum. Some BH programs think the first indications box needs to change, others believe that the second box needs to change meaning if you have no IV or Hx, despite a BP >140 systolic, no NTG should be administered. SWORBP Medical Council does not want to change one way only to change again when the final decision is made by the MAC. Therefore, for now, when the BP is > 140, as per the chart, single doses of NTG are acceptable however the ideal would be to have a prior use or an IV established. Withholding NTG from this subset of patients at this time would also be acceptable until this is clarified at a Provincial level.

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