Nitro before IV

[FFMedic1911]

Whats everyone's take on the question.When dealing with chest pain,Do you always start a line before giving nitro SL.I've seen it both ways.I prefer to start one but would like to hear some other schools of thought.

 

[KEVD18]

line and ekg prior to ntg.

 

[Sasha]

I check the bp, give ntg if its high enough. If its skirting the line, Id start a line first

 

[BossyCow]

You do run the risk of losing the juicy veins with the decrease in BP. Not impossible to get but definitely can be more difficult.

 

[Ridryder911]

Nothing like bottoming out the patient and increasing the infarct size because of a zealous provider.

A twelve lead and IV should be performed before any NTG is administered. Administering NTG before knowing it is not a right sided AMI is only asking for troubles the same as if administering NTG without a line.

R/r 911

 

[KEVD18]

Nothing like bottoming out the patient and increasing the infarct size because of a zealous provider.

A twelve lead and IV should be performed before any NTG is administered. Administering NTG before knowing it is not a right sided AMI is only asking for troubles the same as if administering NTG without a line.

R/r 911

as usual, you're more eloquent in your response.....

 

[NESDMEDIC]

12 lead ekg and line before nitro, the cath lab in my area also likes a second line prior to arrival and the lines to be with an 18 gauge.

 

[FF-EMT Diver]

Definitley a line first,

 

[Hastings]

The ABSOLUTE ONLY situation in which I would consider Nitro before an IV is if the patient is prescribed and/or regularly takes Nitro already. But even in that case, it takes what - 45 seconds? - to start an IV.

Just start the IV first. Lose the pressure without a lifeline and you just made an emergency a...well...bigger emergency.

 

[reaper]

I love seeing the ones that say "their BP was high enough". These are the ones that have never seen a pt with a bp of 170/100 drop to 70/40, after one NTG dose. You have now made the heart work twice as hard, while it is infarcting.

There is a reason why they teach IV first. As Rid stated, you also want a 12 lead before any meds. That way, if the NTG resolved the problem the Dr. can see what was going
on.

If a pt takes their own NTG, they know the risks. We are there to help,not harm.

 

[Hastings]

I love seeing the ones that say "their BP was high enough". These are the ones that have never seen a pt with a bp of 170/100 drop to 70/40, after one NTG dose. You have now made the heart work twice as hard, while it is infarcting.

There is a reason why they teach IV first. As Rid stated, you also want a 12 lead before any meds. That way, if the NTG resolved the problem the Dr. can see what was going
on.

If a pt takes their own NTG, they know the risks. We are there to help,not harm.

220/90 -> 80/? with dizziness and temporary loss of consciousness after one Nitro.

Learned the hard way. Thankfully, had a large IV ready. It's really vital.

 

[rjz]

get the nitro on board

Gotta say that I give nitro before the IV on an very regular basis (read almost always). If someone has chest pain I ask the basic PQRST questions, ask about allergies and sexual enhancing drugs, grab a BP and then the ASA and nitro is started. In the system I work in we strive to have nitro on board within 3 minutes of pt. contact and a 12 lead done within 5 mintues. The basis of everything that we do is to relieve pain and reduce the size of the infarct so get the nitro going, and don't wait around for the IV.

 

[KEVD18]

Gotta say that I give nitro before the IV on an very regular basis (read almost always). If someone has chest pain I ask the basic PQRST questions, ask about allergies and sexual enhancing drugs, grab a BP and then the ASA and nitro is started. In the system I work in we strive to have nitro on board within 3 minutes of pt. contact and a 12 lead done within 5 mintues. The basis of everything that we do is to relieve pain and reduce the size of the infarct so get the nitro going, and don't wait around for the IV.

i seriously hope your service reconsiders this policy after one of your medics kills a pt with a right sided mi.

 

[Hastings]

Gotta say that I give nitro before the IV on an very regular basis (read almost always). If someone has chest pain I ask the basic PQRST questions, ask about allergies and sexual enhancing drugs, grab a BP and then the ASA and nitro is started. In the system I work in we strive to have nitro on board within 3 minutes of pt. contact and a 12 lead done within 5 mintues. The basis of everything that we do is to relieve pain and reduce the size of the infarct so get the nitro going, and don't wait around for the IV.

You can start the IV first and still be well within the 3 minutes.

Should take no more than 45 seconds. You can give the Nitro as soon as IV placement is confirmed. Have someone pop the Nitro in, secure the IV. Together, should be no more than 2 minutes.

 

[marineman]

Odd question to me, our local protocols say 12 lead and an IV must be in place prior to administering any nitro. So that will be the answer I go with but what's everyone's take on the basics that have nitro and can't do a line?

I know locally the pt must either be prescribed nitro or have an order from med. direction stating to give it (have to check with them even if it's prescribed) for basics so they're not out there just spraying people on a whim but it still seems like a potentially dangerous practice. Especially dangerous considering the systolic pressure only needs to be above 100 mm Hg it wouldn't take much of a drop to really create a Charlie Foxtrot (military people know)

 

[KEVD18]

people with their own nitro usually have it for a chronic condition(angina pectoris etc).

bls carrying our own nitro and administering it without iv and ekg findings is reckless and i dont agree with it.

 

[Hastings]

Odd question to me, our local protocols say 12 lead and an IV must be in place prior to administering any nitro. So that will be the answer I go with but what's everyone's take on the basics that have nitro and can't do a line?

I know locally the pt must either be prescribed nitro or have an order from med. direction stating to give it (have to check with them even if it's prescribed) for basics so they're not out there just spraying people on a whim but it still seems like a potentially dangerous practice. Especially dangerous considering the systolic pressure only needs to be above 100 mm Hg it wouldn't take much of a drop to really create a Charlie Foxtrot (military people know)

It has the same dangers as usual, and it makes me uneasy. It is well controlled though. As you stated, BLS usually needs an order from Med Control (which will rarely come). And again, if someone is prescribed Nitro, the patient is usually able to tolerate it well. Can't rely on that though. Should always have a lifeline.

 

[volparamedic]

It's not just the blood pressure its self but how much of a change happens. A blood pressure drop of 30mmHg can make anyone dizzy/near syncope when getting up from laying. I promise you will have a difficult time establishing an IV then. Other times it's not a problem but you can never really tell unless you see right side involvement. Then you can guarentee a drop. Otherwise, use trendelenburg and fluid bolus to get to a safe level to be able to give the nitro.

When you look at leads 2 and 3 and see Inferior MI you should always suspect right side involvement. To check for this, place the red lead at right V4 and other leads as normal then check in lead 3 for ST changes. If you see changes then you have right side involvement. That is when you have the highest probability of a big drop in blood pressure with a nitro. I usually have them chew baby asa while I start the IV (at least an 18GA). It is not uncommon to give 500cc fluid bolus prior to administration of nitro with right side involvement. Check breath sounds if clear give 250cc, recheck breath sounds...if clear give the other 250cc. When you do give the nitro you will then be ahead of the game.

Hope this helps ya!

 

[Ridryder911]

Again many do not understand that NTG itself is not primarily used for AMI's, rather for Angina (the old ruling out Angina vs. AMI technique). Patients are prescribed NTG for angina, NOT an AMI.

Thus the reason so many are against Basic level administering NTG is the potential problems.

R/r911

 

[KEVD18]

, use trendelenburg

here we go again.......................