{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:08:45Z","timestamp":1790816925776,"version":"4.1.0"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X20001193_as1\"><jats:title>Objective:<\/jats:title><jats:p>The study describes the implementation of a prehospital treatment algorithm that included intravenous (IV) bolus (IVB) nitroglycerin (NTG) followed by maintenance infusion for the treatment of acute pulmonary edema (APE) in a single, high-volume Emergency Medical Services (EMS) system.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001193_as2\"><jats:title>Methods:<\/jats:title><jats:p>This is a retrospective chart review of patients who received IVB NTG for APE in a large EMS system in Minnesota and Wisconsin (USA). Inclusion criteria for treatment included a diagnosis of APE, systolic blood pressure \u2265120mmHg, and oxygen saturation (SpO<jats:sub>2<\/jats:sub>) \u226493% following 800mcg of sublingual NTG. Patients received a 400mcg IVB of NTG, repeated every two minutes as needed, and subsequent infusion at 80mcg\/min for transport times \u226510 minutes.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001193_as3\"><jats:title>Results:<\/jats:title><jats:p>Forty-four patients were treated with IVB NTG. The median total bolus dose was 400mcg. Twenty patients were treated with NTG infusion following IVB NTG. The median infusion rate was 80mcg\/min. For all patients, the initial median blood pressure was 191\/113mmHg. Five minutes following IVB NTG, it was 160\/94mmHg, and on arrival to the emergency department (ED) it was 152\/90mmHg. Five minutes after the initial dose of IVB NTG, median SpO<jats:sub>2<\/jats:sub> increased to 92% from an initial reading of 88% and was 94% at hospital arrival. One episode of transient hypotension occurred during EMS transport.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X20001193_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Patients treated with IVB NTG for APE had reduction in blood pressure and improvement in SpO<jats:sub>2<\/jats:sub> compared to their original presentation. Prehospital treatment of APE with IVB appears to be feasible and safe. A randomized trial is needed to confirm these findings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x20001193","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T07:28:31Z","timestamp":1602055711000},"page":"663-668","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Prehospital Treatment of Acute Pulmonary Edema with Intravenous Bolus and Infusion Nitroglycerin"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9710-1523","authenticated-orcid":false,"given":"Michael C.","family":"Perlmutter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan S.","family":"Stratton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Conterato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"key":"S1049023X20001193_ref2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200002000-00007"},{"key":"S1049023X20001193_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.02.022"},{"key":"S1049023X20001193_ref21","unstructured":"21. 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Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology\/American Heart Association Hypertension Guideline","volume":"168","author":"Carey","year":"2018","journal-title":"Ann Int Med."},{"key":"S1049023X20001193_ref16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7133.2009.00112.x"},{"key":"S1049023X20001193_ref23","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1093\/eurheartj\/ehi044","article-title":"Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology","volume":"26","author":"Nieminen","year":"2005","journal-title":"Eur Heart J."},{"key":"S1049023X20001193_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/10903120600884848"},{"key":"S1049023X20001193_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(97)70009-X"},{"key":"S1049023X20001193_ref20","doi-asserted-by":"crossref","unstructured":"20. Patrick, C , Ward, B , Anderson, J , et al. Feasibility, effectiveness and safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema. Prehosp Emerg Care. 2020. 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