CHF/Pulmonary edema 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes. 

□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg		□ Bilateral rales 
□ Jugular vein distention 
□ Pinky, frothy sputum 
□ Peripheral edema 
□ Diaphoresis 
□ Hypoperfusion 
□ Hypotension 
□ Chest pain 
□ Respiratory distress 
□ Apprehension/anxiety 
□ Orthopnea 		□ Myocardial infarction 
□ Congestive heart failure 
□ Pulmonary embolus 
□ Pericardial tamponade 
□ Pleural effusion 
□ Pneumonia 
□ Asthma 
□ Anaphylaxis 
□ Aspiration 
□ COPD 
□ Toxic exposure 

Clinical Management Options

EMT-B
• Oxygen target SpO2 92 – 96% 
• Position of comfort 
• Basic airway management 
• Aspirin if suspected ACS Chest Pain
Paramedic
• Vascular access 
• Consider CPAP with PEEP (5-20 cm H2O) with rales/rhonchi indicating wet lung sounds 
• Nitroglycerin q 5 minutes if SBP > 100 mmHg 
• SBP 100 – 149 mmHg: 0.4 mg SL
• SBP 150 – 199 mmHg: 0.8 mg SL
• SBP 200 or greater: 1.2 mg SL
• 4 lead and 12 lead ECG placement and acquisition 
• Monitoring and interpretation of ECG, waveform EtCO2
• Advanced Airway as needed
Consult Online Medical Control as Needed

Pearls

  • Avoid Nitroglycerin in any patient who has used Viagra or Levitra in the past 24 hours or Cialis in the past 48 hours or other PDE erectile dysfunction medications due to potential severe hypotension. 
  • Careful monitoring of level of consciousness, BP, and respiratory status with above interventions is essential. 
  • Consider myocardial infarction in all these patients. If suspected give Aspirin. 
  • Allow the patient to be in their position of comfort to maximize their breathing effort. 
  • Patient BP may drop with CPAP, if CPAP is necessary for oxygenation/ventilation, may move to add pressor.