CPRinProgress
Forum Lieutenant
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In Jersey I'm not sure if we are allowed to administer nitro that isn't prescribed. My squad definitely doesn't carry it
BLS Skills -- What Should We Add?
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In Jersey I'm not sure if we are allowed to administer nitro that isn't prescribed. My squad definitely doesn't carry it
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I don't know of many places that allow EMTs to carry and dispense their own Nitro. This is a thread discussing what should or should not be in the BLS scope.
Clare
Forum Asst. Chief
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I stand corrected. Forgive me for momentarily forgetting our fine non-USA members.
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A very good chunk of Texas (I don't know anywhere but small IFTs that don't allow them to carry and administer)
JPINFV
Gadfly
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...because those patients have been worked up and diagnosed with angina. That's completely different than the first time a patient suffers from acute coronary syndrome.
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The education behind BLS providers in those countries is a little different than here in the states though...
DesertMedic66
Forum Troll
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As ive said before on the Nitro issue, the reason these countries bls paramedics (all ems providers are medics, except for first responder level) can carry and give nitro is due to education. Before nitro is administered, we must have a 12 or 15 lead ekg to rule out rv mi. If the pt does not have a hx of nitro use, then we must get iv access.
This is different from pt self administration of nitro since in that case it is known that the pt did not have rv mi or similar issues when it was prescribed. In an ems setting without knowing the patient the 12 lead is a valid precaution.
Dropping the blood pressure of a preload dependant pt is not a good idea.
Yes the nitro will wear off, but if you have to give a fluid bolus to bring the pressure back up you've got another set of problems in certain pts. Once the vascular bed tightens back up after the nitro wears off then the pt has a ton of excess blood volume (assuming the fluid hasn't third spaced). This may not cause a problem in pts who were fluid responsive or tolerant to begin with, but could cause issues if they were volume loaded or overloaded.
This is different from pt self administration of nitro since in that case it is known that the pt did not have rv mi or similar issues when it was prescribed. In an ems setting without knowing the patient the 12 lead is a valid precaution.
Dropping the blood pressure of a preload dependant pt is not a good idea.
Yes the nitro will wear off, but if you have to give a fluid bolus to bring the pressure back up you've got another set of problems in certain pts. Once the vascular bed tightens back up after the nitro wears off then the pt has a ton of excess blood volume (assuming the fluid hasn't third spaced). This may not cause a problem in pts who were fluid responsive or tolerant to begin with, but could cause issues if they were volume loaded or overloaded.
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True but t here no reason there current signs and symptoms couldn't have RVI...
We can give nitro without a line with a SBP >100 and no inferior STEMI but I still make a habit of having a line before the nitro unless they're hypertensive and it's not a line we can nab quickly.
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Bullets
Forum Knucklehead
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Dropping the blood pressure of a preload dependant pt is not a good idea.
Yes the nitro will wear off, but if you have to give a fluid bolus to bring the pressure back up you've got another set of problems in certain pts. Once the vascular bed tightens back up after the nitro wears off then the pt has a ton of excess blood volume (assuming the fluid hasn't third spaced). This may not cause a problem in pts who were fluid responsive or tolerant to begin with, but could cause issues if they were volume loaded or overloaded.
Science doesnt back you up on this. Studies show that nitro doesnt drop BP that much, and the body regulates it pretty well
Also, if a patient has prescribed nitro, and has chest pain, whats to say he isnt having a RVI then? he doesnt have a EKG, he just takes the nitro
MountainMedic
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Nitro doesn't normally drop BP that much, but if the patient is having a RVI or is in pre-cardiogenic shock, it will tank it. IMHO, it should not be given without a 12-lead (15-lead, really), by a medic, ever.
Most physicians who prescribe NTG to their patients will only do so after EKG and echocardiogram. Their pt will have a calculated risk for RVI, and coronary artery blood flow will likely be assessed before NTG is prescribed.