In the adult CHF/pulmonary edema protocol, which noninvasive ventilation method is recommended?

• A. CPAP 10 cmH2O
• B. Lasix 40 mg IV
• C. Oxygen by nasal cannula
• D. Nitro-Paste 1" to the anterior upper chest

Answer: (C)

In this scenario, the main idea is how to support breathing without invasive measures in acute CHF with pulmonary edema. The safest starting move is to provide supplemental oxygen that’s easy to tailor to the patient’s needs. Oxygen by nasal cannula is chosen because it offers a simple, well-tolerated way to raise the blood's oxygen level and lets clinicians adjust the FiO2 to reach a target saturation without forcing the patient into a mask or a higher-pressure ventilation mode. It keeps things comfortable and easy to manage, especially if the patient isn’t in severe distress yet.

Noninvasive positive-pressure ventilation, like CPAP, is then considered if oxygen alone isn’t enough or if there’s significant work of breathing, because it delivers positive airway pressure to recruit collapsed alveoli and reduce the heart’s workload by lowering preload and afterload. The other options—diuretics and nitro patches—address fluid status and preload/afterload, but they don’t provide ventilation support. So starting with nasal oxygen aligns with the protocol’s approach to begin with practical, noninvasive oxygenation and escalate only if needed.