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Published online: 2023-10-18

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THE PRE-HOSPITAL EMERGENCY HEALTH SERVICES ADHERENCE FOR ACUTE CARDIOGENIC PULMONARY EDEMA TREATMENT PROTOCOLS

Sezgin Durmuş1, Ali Ekşi1
DOI: 10.5603/demj.96223

Abstract

INTRODUCTION: Acute Cardiogenic Pulmonary Edema (ACPE) has been the subject of Prehospital Emergency Health Services (PHEMS) for many years and is included in treatment protocols. Although these protocols were created from current literature information with proven accuracy, the rapid developments in the medical literature can sometimes take time to reflect on protocols and some differences may occur between the literature discussions and protocols. This study aimed to examine the differences between PHEMS protocols and current literature discussions in ACPE and the effects of these differences on PHEMS personnel.

MATERIAL AND METHODS: The present study, which was planned in descriptive type, consisted of two stages. In the first stage, the PHEMS protocols were examined worldwide, and seven protocols, which included the ACPE treatment protocols, were evaluated. In the second stage, questions were asked to the participants, including current information about the treatment of ACPE, and whether they followed up-to-date literature information. Participants were asked to answer the questions with their up-to-date knowledge regardless of the PHEMS protocols they were responsible for. The sample consisted of 600 participants and the data were collected between February and April 2022.

RESULTS: It was observed that Continuous Positive Airway Pressure (CPAP) application was included in all the protocols evaluated, that there were differences in nitrate usage dose and furosemide application, and that aggressive nitrate application was not included in any of the protocols. In this study, 67.2% of the participants stated that they followed up-to-date information about their profession; 32.7% would prefer the use of aggressive nitrate in SPD, 33.8% would apply furosemide if the patient did not feel relief after nitrate use, 29.7% would apply morphine sulfate, and 70.5% would apply CPAP if there were an indication.

CONCLUSIONS: The differences between the PHEMS protocols and the current literature on the treatment of ACPE may cause confusion among PHEMS personnel. Further studies are needed to clarify protocols for the aggressive use of nitrates and furosemide. In the case of morphine sulfate use, limitations and side effects should be stated more clearly.

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