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I would not think of NTG as providing even a "temporary fix." It's used for pain control, essentially. Aspirin in MI, however, saves 1 life out of every 50 patients who get it. (Well, at least in the pre-lytic, pre-PCI era) Besides the obvious stuff you know (don't give in hypotension, after...

First off (and I won't be the only guy to point this out), nitro has not been shown to "get rid of infarcting tissue," reverse an AMI, or decrease mortality. There are a number of cases where ST segments have normalized after NTG, but I don't think anyone believes that the essential process has...

Breakfast, lunch and dinner at the Frontier on Central, right across from UNM. Put the green chili on everything! (This ain't Texas chili, it's NM chili - infinitely better!) Great place to study too.

Sorry I keep busting in, but you keep bringing up good questions! From the journal Prehospital Emergency Care, a recently published abstract directly addressed this issue. I talked about this study at length in a recent review - check it out if you want background, other references, etc...

Better? Sounds like you did fine. He was conscious ("screaming"), and the BiPAP helped, so there you go. Just because the ED decided to RSI doesn't mean that you should have. They've got better drugs, more staff, back-up anesthesia and surgery. What makes sense doing in a fully-equipped ED...

We're all band-aids, and that's only if we're good at what we do. EMT-B, ED doc, ICU doc - we're all working to "cure sometimes, to relieve often, to comfort always."

Interesting case! You've given us a lot of data, which is helpful, but it leaves me wanting more! Great call not dumping him on the level-4! What ever was going, hypoxic and combative needs to get some stuff done, and quick. I'll give my opinion that it's pretty unlikely he had DKA...

One of the guys who posts here, Brandon, runs a great blog called EMS Basics. The title of the blog is a little misleading - he covers topics in the scope of the EMT-B, but dives a little deeper than, say, your text from class. So, it's for basics, but isn't basic. Sounds like what you're...

America's health-care "system;" the medic has the education and the motivation, and even has a helicopter available, but not a 12-lead capable machine. Even one of jwk's hand-me-downs.

Whenever I try to explain this crucial point about monitor versus 12-lead quality, I end up waving my hands in the air, saying stuff like "You know, frequencies..." I don't have much of an electrical background, so I copied the information from the relevant Wikipedia article. If you take a...

The problem is that your monitor/defib is not set up to appropriately display STE/STD, or other morphologic changes. It is reading certain frequencies of electrical input, those that give you an accurate reading of intervals; QRS duration, QTc, etc.. There are electrical filters designed to...

If Braunwald is in my ED for a consult, I'd ask him if he wanted to give the atropine (or norepi, or pacing) to treat the STE, but I think otherwise we'll be getting the cath lab warmed up regardless!

Well, you had me sweating that I forgot the normal PaCO2 or something!

How did we come up with different #?

663 Had to be able to do the math at one time, now I use Google. And then I checked with the wife (pulm doc). Edit: I used this website for a refresher on the equation PAO2 = FIO2(PB-47) - 1.2(PaCO2) To do the actual calculation, I used an on-line calculator

TomB - I love this topic! It can get overwhelming though, so let me see if I can summarize what has been described so far. Hypotension and bradycardia after NTG administration could be seen in a few distinct contexts: 1) In a patient with no ongoing ACS, the NTG can trigger a BJ reflex...

A constant infusion of furosemide is more effective, and actually less associated with side effects than bolus dosing. Generally this matters more when you are giving large doses, or there is impaired GFR. Edit: Was the dopamine dose really meant to boost renal function, or was it just low-dose...

That's a good point to make, since we could be talking about two mechanisms of hypotension in inferior MI post-NTG. Transient reduction of preload in the poorly-contracting RV myocardium, or direct effect of ischemia on the conduction system. I haven't seen any discussion that suggests that...

That was faster than I thought it would be. I do think I have to be careful calling it the "BJ" reflex in mixed company. It just seems like, I don't know, there's a certain possibility of misunderstanding... As a technical explanation, though, I think it's right on the money! I wrote the...

Ah, I should have mentioned one thing, and it's important. The patient ended up ruling-out for ACS. Actually, in both my case and the medic's case. So, no ischemia or thrombus, no RV ischemia!