EMS Protocol of the Week - Respiratory Distress/Failure/Pulmonary Edema (Adult)

Despite the broad-sounding title, the prehospital protocol for respiratory distress/failure and pulmonary edema serves mostly to describe the pulmonary edema aspect of care.  As we’ve seen, there are separate, more specific protocols of obstructed airways and COPD/asthma exacerbations, leaving this protocol to mostly focus on fluid overload.

Of note, this protocol also refers to Appendix P (attached), which describes indications for prehospital CPAP use. Remember that CPAP can be applied at either the BLS or ALS level, which has been of tremendous utility in caring for these patients.

At the ALS level, paramedics will administer nitroglycerin (either via tablet or spray) as indicated. You may receive OLMC calls from them requesting to give a benzodiazepine (for CPAP-related anxiety) or furosemide (to get a jumpstart on diuresis). Approve or deny the request as you choose; just remember to confirm dosages and routes!

That’s it for this week, gang! One more protocol to…take your breath away!

Goodbye!

www.nycremsco.org or the protocol binder for more

Dave