CHF / Pulmonary Edema




  • CHF
  • Past medical history
  • Medications (Digoxin, Lasix)
  • Erectile dysfunction medication
  • Cardiac history (MI)


Significant findings:


  • Severe SOB
  • Air hunger
  • Diaphoresis
  • Tachypnea
  • Tachycardia
  • Chest pain
  • Elevated blood pressure
  • Peripheral edema
  • Pink, frothy sputum
  • Bi-lateral rales


CHF vs Differential:


  • MI
  • CHF
  • COPD
  • Asthma
  • Anaphylaxis
  • PE
  • Aspiration
  • Pneumonia
  • Pleural effusion
  • Pericardial tamponade
  • Toxic exposure




  • Oxygen
  • 12-Lead EKG
  • Initiate IV/IO


Consider Acute Coronary Syndromes Protocol


  • Assess symptom severity
  • Allow patient to maintain a position of comfort (usually sitting)




  • Normal HR
  • Elevated or normal BP




    • Yes


  • Notify receiving facility or contact Medical Control


    • No



      • Apply CPAP (EMT/Medic)





  • Elevated HR
  • Elevated BP




  • Apply CPAP (EMT/Medic)



    • Notify receiving facility or contact Medical Control




  • Avoid Nitroglycerin in any patient who has used erectile dysfunction medication (i.e., Viagra or Levitra within 24 hours, or Cialis within 36 hours)
  • For administration of Nitroglycerin, systolic blood pressure must be greater than 90 mmHG. May be repeated at 5 minute intervals if dyspnea is not relieved and systolic blood pressure remains greater than 90.
  • Systolic blood pressure must be greater than 100 for Nitroglycerin administration if 12 Lead EKG and peripheral IV are not available. Blood pressure must be obtained again prior to additional administration of Nitroglycerin
  • For Conscious Sedation, see Sedation/Anxiety protocol. Dose should be titrated to provide comfort without causing unconsciousness ore respiratory failure. Be sure to monitor patient's breathing/ventilations, blood pressure and O2 saturation.
  • Once CPAP is in use, apply 1 inch Nitroglycerin Paste.
  • Nitroglycerin Paste is applied to upper chest and further doses of sublingual Nitroglycerin can be withheld. Remove paste and wipe chest clean if systolic blood pressure is less than 90.
  • For use of CPAP, systolic blood pressure must be greater than 90