Lasix protocols in acute pulmonary edema

[bbbrammer]

I'm curious. Lasix is contraindicated in hypotensive pts, but in your services what is your bottom marker for evaluating hypotension? Systolic less than 100, 90, 80, etc? How hypotensive does someone in acute pulmonary edema with a hx of CHF have to be before you draw the line on Ax. Lasix?

I am looking for different protocol standards here.

[Ridryder 911]

Ours is systolic below 90 or appears to be hemodynamic compromised. It is based upon the medics "judgement". I personally prefer not to administer a diuretic on top of NTG, M.S. CPAP etc.. if the pressure is already going down. Adding fluids is not going to help them, and unless I can initiate med.'s for pre and after load (Dopamine & Dobutamine), you are going to get screwed.

R/r 911

[emt322632]

Here we have to have a systolic BP >100 to push lasix and nitro both. Anything under that is considered a no no.

[kevkei]

Lasix is being removed from our inventory. Cited reasons are that it poses more risk than benefit and that even in the in hospital environment with radiographic imaging, pulmonary edema is only correctly diagnosed 40% of the time.

[fiznat]

Our protocols dont specify a minimum BP for administration of lasix, although I think it is assumed to be a precaution. ...Especially when you're also doing NTG and CPAP. NTG and CPAP both require a systolic over 100mmHg. Morphine we would have to call for, so I assume BP would be a precaution there as well.

[Connie31079]

Here's our protocol for Lasix (look under furosemide):

http://www.gov.ns.ca/health/ehs/Medical_Di...ns%20Master.pdf

Connie

[CBEMT]

Only a bottom limit for Nitro- 150 systolic with no line in place.

[bbbrammer]

Thank you guys for all your imput. Connie especially simply because it was nice to see how your company protocols were written up. We are re-writing ours into a more user friendly edition instead of the novel edition we have now. I may use ya'lls setup as an example of how easy they can be written. Thank you.

Our state protocols prohibit lasix if the systolic is less than 90mm Hg, but I wondered how other services/states/countries handled it.

Thank you for your responses, I appreciate it.

[MTNMANMEDIC]

Only a bottom limit for Nitro- 150 systolic with no line in place.

B.S.: Systolic for Nitro is 100, not 150, 100 is National Standard and is taught in every EMT-B class that I know of.

No mention of line in place.

FUROSEMIDE

CT/I P

(LASIX)

INDICATIONS: CHF;pulmonary edema

CONTERAINDICATIONS: Hypontension, pregnancy,hypokalemia

EFFECTS: Increases urine output; vasodilation

SIDE EFFECTS: Dehydration, decreases potassium

HOW SUPPLIES: 40mg/ml

QUANITY: 3

NITROGLYCERINE

INDICATIONS: Chest pain of suspected cardiac orgin;

pulmonary edema; hypertensive crisis

CONTRAINDICATIONS: Hypotension, trauma,ICH,use in consultation with MEDICAL CONTROL PHYSICIAN with patients using Viagra, Levitra and Cialis

EFFECTS: Vasodilation

SIDE EFFECTS: Headache, Hypotension and dizziness

HOW SUPPLIES: 0.4 mg (tablet), 1/150th grain

QUANITY: 1 bottle

DOSAGE & ROUTE: 1 tablet SL every 5 min.

DOSAGE AND ROUTE: 40mg IV over 2-3 min. May consider higher dose for patients already on diuretics.

Pediatric: 1-2mg/kg

CHEST PAIN PROTOCOL FOR EMT-B

Adult- Cardiac: Chest Pain (Suspected Myocardial Event)

1. Administer 02

2. Asprin 162 mg (2 baby asprin) chewed.

3. Assist patient with prescribed Nitroglycerin (NTG) 1 tablet SL every 5 minutes as long as SBP > 100mmg, to a maxium of 3 doses.

KNOW YOUR PROTOCOLS IF YOU DO NOT HAVE THE EDUCATION TO KNOW ANYTHING ELSE.

[CBEMT]

Yeah, I f@#$ed that up, I realized it today. I think I was thinking about some dumbass at work that was talking about not giving it below that limit, but as his personal preference. Up late, the wires crossed in my head, that's the result.

So I looked it up (just for you) and the protocol is actually 90 systolic, which is exactly what I thought it was.

KNOW YOUR PROTOCOLS IF YOU DO NOT HAVE THE EDUCATION TO KNOW ANYTHING ELSE.

SO, you can take that comment and..........

Well, I'll keep it civil.