Nitro or aspirin first......?

[Shishkabob]

People take NTG all the time without taking their VS first and when no one is around to start an IV. BLS also administers it in some places, without getting an EKG first.

Also, the evidence does not appear supportive of the idea that right-sided involvement tends to result in significantly greater rates of hypotension.

Although I do a 12lead before NTG, it's not for fear of an RVMI, it's due to the things that may disappear post-nitro, such as Prinzmetal's angina, that you really want proof of.

 

[STXmedic]

Although I do a 12lead before NTG, it's not for fear of an RVMI, it's due to the things that may disappear post-nitro, such as Prinzmetal's angina, that you really want proof of.

Holy crap, Linuss is alive!

 

[Carlos Danger]

Although I do a 12lead before NTG, it's not for fear of an RVMI, it's due to the things that may disappear post-nitro, such as Prinzmetal's angina, that you really want proof of.

My comments were more aimed at the statement "you really should have an IV before you give nitro".

 

[JPINFV]

Didn't take the time to make the meme this time?

Nope... I'm too busy responding to BS rapid response calls (no... I'm not going to update a family on a patient I've never treated at 9:30 pm because... I know nothing about this patient) or BS calls (The patient admitted for sepsis today and on antibiotics had a fever when he came in... you don't say...") to make memes.

 

[Nova1300]

Nope... I'm too busy responding to BS rapid response calls (no... I'm not going to update a family on a patient I've never treated at 9:30 pm because... I know nothing about this patient) or BS calls (The patient admitted for sepsis today and on antibiotics had a fever when he came in... you don't say...") to make memes.

Ahhhhh nightfloat. Where you can be harassed all night and try to make the right decisions on patients you don't know, only to be scolded by the primary-team attending the next day for making the right decisions on patients you don't know.

 

[Angel]

per protocol were supposed to get the 12 lead first BUT ive given nitro to a pt with a R sided MI and the decrease in BP was negligable. not saying thats always the case but we have the tools to treat it in case that happens. anyway, since we have nitro spray here, its a lot easier to spray then waiting for them to chew or dissolve the nitro/asa
if it was both tabs then ASA first for the same reason. IMO asa is a bit more important at first than nitro

 

[JPINFV]

Ahhhhh nightfloat. Where you can be harassed all night and try to make the right decisions on patients you don't know, only to be scolded by the primary-team attending the next day for making the right decisions on patients you don't know.

Technically call team. Interns on IM call go until 10 with night float going from 10pm-7am (and then doing floor work until 11am for their patients).

 

[Ewok Jerky]

per protocol were supposed to get the 12 lead first BUT ive given nitro to a pt with a R sided MI and the decrease in BP was negligable. not saying thats always the case but we have the tools to treat it in case that happens. anyway, since we have nitro spray here, its a lot easier to spray then waiting for them to chew or dissolve the nitro/asa
if it was both tabs then ASA first for the same reason. IMO asa is a bit more important at first than nitro

I know you know this Angel, but just to clarify for those who might not:

Nitro can be a bad idea for RMI because of a drop in pre-load, not so much BP (although they are related). When nitro vasodilates, it not only drops after-load to give the L ventricle a break, but it also drops preload, giving the R ventricle less to work with leading the L ventricle to be less competent at perusing coronary arteries.