Do your protocols include...?

[Urbanmedic461]

I'm currently working on a research paper for my advanced care training. My focus is on the need for change in prehospital treatment of CHF/Cardiogenic pulmonary edema.

What I'm looking to find is if any services out there are currently using ACE inhibitors in their Cardiogenic Pulmonary edema protocols. More specifically the use of sublingual captopril, and to a lesser degree IV enalapril.

If your service, or a service you know of currently uses this treatment I would like to know about it.

If you could reply with some info (country, city, ACE inhibitor used, and dose) it would be much appriciated. If you could pass along a copy of the actual protocol that would be even better! Also any insight or debate on the subject would be welcomed.

FYI - Main points of my paper

*Obviously the inclusion of sublingual captopril

*Removal of furosemide all together

*Use of CPAP

*Create a more systematic approach to CHF/CPE protocol all together.

I may post up my paper once it has been reviewed and marked.

[tskstorm]

Nope sorry,

We have done away with Lasix though. Main treatment here is nitrates and CPAP.

[fiznat]

Yeah, CPAP and NTG are working pretty well here.

[JakeEMTP]

Our protocol is as the others have posted. NTG and CPAP. Lasix is still available, but requires medical direction.

I have posted the protocol for your perusal.

http://www.ncems.org/pdf/Pro28-PulmonaryEdema.pdf

[Fox800]

I don't have the document in front of me, but I know that we will be getting IV enalapril with the latest revision of our clinical guidelines. We also utilize NTG paste and tablets, Lasix (hopefully this will go away) and CPAP. When I get a copy of the new guidelines, I'll post them up.

[Flasurfbum]

Assess and secure airway via most appropriate device

Establish IV access

20mg Lasix

0.4mg NTG SL q5min, up to 3 times.

Call medical control.

Often times we will get orders for 1in NTG paste, SL NTG PRN, PRN orders for Etomidate, Versed and intubation, PRN orders for CPAP if we haven't used it already, and occasionally 20mg more Lasix.

God Bless NJ MICU.....

[Fox800]

Our new protocols will have a 1.25mg IV dose of enalapril for CHF/pulmonary edema with a systolic BP >140 after NTG paste/tab administration.

[+medic]

I'

*Use of CPAP

Speaking as a BASIC

EMT-B cant use CPAP in N.H. it looks really cool and would be great to use but we cant use it. But the word is that someday soon we will be able to use CPAP. It shown in the new EMT-B book and has alot of page space dedicated to it so hopfully we will get to use it.

As for the rest of the the info you need I dont know since I am a new U.S. EMT currently looking for his first US based EMS job. I will gladly read your paper when you finish it since im always looking for new insite and info about EMS.

Edited June 4, 2010 by +medic

[chbare]

Our new protocols will have a 1.25mg IV dose of enalapril for CHF/pulmonary edema with a systolic BP >140 after NTG paste/tab administration.

We also have a guideline that is very similar to what you wrote.

Take care,

chbare.