Comparison of nitroglycerin, morphine and furosemide in treatment of presumed pre-hospital pulmonary edema.

We compared four treatment protocols in 57 patients with presumed pre-hospital pulmonary edema. Group A patients were treated with nitroglycerin and furosemide, group B patients with morphine sulfate and furosemide, group C with all three agents, and group D with nitroglycerin and morphine, but without furosemide. Twenty-three percent of our patients were ultimately found not to have pulmonary edema, with pneumonia and/or exacerbations of chronic lung disease the most frequent alternate diagnoses. Group A patients had significantly greater improvement, both subjectively and objectively, than group B patients, a substantial number of whom failed to improve, or even worsened. There was no evident synergistic effect of any of the drugs, and some indication that furosemide might have caused clinically important problems with fluid and electrolyte management in some of the patients. Our data suggest that nitroglycerin is beneficial in the management of presumed pre-hospital pulmonary edema, while morphine and furosemide may not add anything to its efficacy, and may be potentially deleterious in some of these patients.