Administering nitroglycerin for cardiac patient

vquintessence said:
I'm assuming he [instructor] is referring to the pt breathing on the NTG spraying device, and all the contagions being able to indefinitely survive in the outside environment, ready to spring upon the unsuspecting cardio/pulmonary pts.

But yeah, I'm with your determination.
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Perhaps, but for us NTG spray is one time use. After the few shots it goes with the Pt. or into the garbage. No cross contimination. I sure as heck hope there's not areas where the meds are being used for multiple patients.
 
WolfmanHarris said:
Perhaps, but for us NTG spray is one time use. After the few shots it goes with the Pt. or into the garbage. No cross contimination. I sure as heck hope there's not areas where the meds are being used for multiple patients.
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That is a hell of a lot of waste of medications...
 
jtpaintball70 said:
That is a hell of a lot of waste of medications...
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Unit cost for the service is $0.17 per NTG spray.
Can't remember for the salbutamol. I don't work in management, I was just told that figure once by a Superintendent during a chat.

Better waste than cross contamination. Though I find working in health care does run headlong into my eco-friendly side. Especially when I don my fourth or fifth pair of gloves for the call.
 
NTG spray here is around $100 a bottle. No way that is going to be wasted. The tip should never come in contact with the pt and it should be cleaned after each use.
 
Mass BLS protocol

BP greater than 100 mmHG, Assist PT 0.3 - 0.4 mg SL; q 3-5 minutes prn to maximum of 3 doses. NTG spray: 0.4 mg under the tongue; 1-2 sprays.
 
the_negro_puppy said:
Our protocol is pretty similar except

HR 50-150
Systolic bp greater than 100
No current CVA or suspected ehad injury
Precaution for inferior MI
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Puppy, you're missing one contraindication... (on my skim through I don't think it's been mentioned anywhere else).
 
Lack of viagra
 
Linuss said:
Eh, I do my own loophole for my EMT when giving nitro. Our protocols state that EMTs can only give prescribed nitro... technically every drug a Paramedic gives to a patient is prescribed for that patient at that time by standing orders, therefor I allow my EMT to give the trucks nitro.


I'm going to give it anyhow, so it's really of no difference.
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Ahh yes, but we are a bls unit, so unless we dispatch the medics there's no other nitro around...given, we do always dispatch them for chest pain, but sometimes you have to wait a wee bit for them to get there so it's your own nitro and a non rebreather till they get there...and if you need another before they do, I have to call medical command...still gets me off the hook...until the medic gets there and throws his tackle box at me. Eeesh. Why are all the caps gray in that thing. I'm totally going to hand him the wrong "one with the gray cap" one of these days.
 
Sassafras said:
Or ciallis

And ask the ladies too since apparently they are experimenting with it now.
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More likely is that they were taking it for an off label usage for pulmonary hypertension of reynaud'. Hence the repackaging and remarketing of Revatio for that purpose.
 
Anyone else have VT as a a C/I?

I don't hear much talk about RVI/Inferior STEMI either. Maybe not as a CI but precautions...reduced doses.
 
Melclin said:
Anyone else have VT as a a C/I?

I don't hear much talk about RVI/Inferior STEMI either. Maybe not as a CI but precautions...reduced doses.
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V/T is a CI in NM for medics giving the drug as well. And might be for NM EMT-Is as well
 
Linuss said:
Depends on your protocols.
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Here we were taught that if the patient has taken Viagra within 36 hours we should not administer Nitro... But yeah, that might just be our protocols. I don't know.
 
As for the original OP's question.... generally spray or tablet it doesn't really matter which is used. They are both nitro of the same dose just different delivery methods. They will have the same effect.

Absorption can be considered a factor in which type an EMS service carries. The sub-lingual tablet needs to dissolve under the tongue before it can start to work. The spray (being in a liquid form) does not need to undergo the same transformation process prior to absorption. So the spray should start to work sooner then a SL tablet. I've not seen any study that say's one has a better efficacy then the other but its makes perfect sense how a spray would work faster. Also, if a patient has dry mouth the SL nitro tablet will have a hard time dissolving. In this case you can squirt some normal saline under the tongue to aid the tablet in dissolving.

I had a priority patient once we were treating with SL captropril... we got to the ED and the captopril was still in solid form with very little dissolving due to the patient having really dry mucus membranes...

All nitro spray I have seen used on an EMS unit is multi-patient use. The bottle does not come into contact with the patient. To me it seems really wasteful to ditch a full bottle of perfectly good nitro spray.

The SL tablets are much cheaper than the nitro spray. I personally prefer the spray.
 
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Linuss said:
Eh, I do my own loophole for my EMT when giving nitro. Our protocols state that EMTs can only give prescribed nitro... technically every drug a Paramedic gives to a patient is prescribed for that patient at that time by standing orders, therefor I allow my EMT to give the trucks nitro.


I'm going to give it anyhow, so it's really of no difference.
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I had a patient this morning which chest pain and PMHX of cardiac problems, I called OLMC for permission to assist with the patients nitro... received permission, and then said.... oh... by the way the patients SL tablets are expired. Med Control said use what we have on board. Pt got the spray...

I Should also mention ALS was en-route, and in radio communications and knew what was going on.
 
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clibb said:
Here we were taught that if the patient has taken Viagra within 36 hours we should not administer Nitro... But yeah, that might just be our protocols. I don't know.
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We have...
Viagra 24
Cialis 36
 
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