When a patient is STEMI positive with Acute Cardiogenic Pulmonary Edema, how many nitro should be administered and why?
The answer to your question has multiple folds and will depend on your initial working diagnosis, treatment plan as well as information gathered monitoring your patient after you started your initial treatment plan.
If your initial working diagnosis/priority is cardiac ischemia with shortness of breath as a secondary diagnosis, you may have findings leading you to STEMI positive evidence early during the call, and most likely gather that information prior to nitro administration.
If your initial working diagnosis/priority is moderate to severe respiratory distress and you later consider cardiac ischemia, you may have findings leading you to STEMI positive evidence later during the call, possibly after starting nitro administration.
In the context of a STEMI positive patient with Acute Cardiogenic Pulmonary Edema (ACPE), we recommend your treatment plan goals are tailored to the patient’s needs and would include maintaining oxygenation as well as coronary perfusion. Coronary perfusion is highly dependent on preload and can be monitored by assessing the blood pressure values.
For that reason, in situations where your patient is in ACPE but also presenting with STEMI, it would be preferable to limit the administration of nitro to 3 doses to avoid the risk of hypotension and cardiogenic shock.
Please consider in your treatment plan a 12-lead ECG acquisition for all patients in ACPE to determine the presence of STEMI and adapt your treatment plan accordingly once you are aware if patient is STEMI positive or negative.
Once STEMI is recognised, no doses beyond 3 should be administered.