Prehospital CHF =============== - NTG is useful, but Lasix and MSO4 are probably not. - 23% of suspected CHF was really something else (pneumonia, COPD exacerbation) [Hoffman J, Reynolds S. Comparison of nitroglycerine, morphine and furosemide in treatment of presumed pre-hospital pulmonary edema. Chest 1987(?1988);92(4):586-593.] (abstract: ) - Prehospital medications were correlated with decreased mortality in critical patients in a retrospective study. [Wuerz RC, Meador SA. Effects of prehospital medications on mortality and length of stay in congestive heart failure.] (abstract: ) Lasix?(furosemide) intravenous (IV), one to two times the patient's usual dose, or 40 mg if the patient does not usually take the drug. Morphine sulfate. Initial dose, 4 to 8 mg IV (subcutaneous administration is effective in milder cases); may repeat in 2 to 4 hours. Avoid respiratory depression. Morphine increases venous capacity, lowering left atrial pressure, and relieves anxiety, which reduces the efficiency of ventilation. Nitroglycerin IV 5 to 10 ug/min. Increase by 5 ug/min q 3 to 5 minutes. Reduces left ventricular preload. Caution: may cause hypotension. Oxygen 100% given to obtain an arterial PO2>60 mm Hg. Position patient sitting up with legs dangling over the side of the bed. This facilitates respiration and reduces venous return.