Nitro or not?

[Akulahawk]

I decided not to give NTG in this case but the thought crossed my mind so wanted to see what others would have been thinking.

Even in a "normal" heart that is volume overloaded, NTG can have some benefit to expand the vasculature to reduce preload which would be beneficial just like in CHF. This is what I was thinking when considering NTG. Any additional thoughts?

I carry NTG infusions ans paste for use in pulmonary edema cases like CHF. we also still carry lasix and bumex if we need diuretic. CPAP is still my primary go to for it though.

While nitroglycerin is very good at vasodilation, I'm not that big of a fan of the sublingual tabs or sprays because you're not able to titrate it for effect. I'm not saying you can't use it, but I would be overjoyed if we could do nitro infusions around here for that, but even given the 1 min ETA this patient had to the ED, if I had to treat this patient, I'd probably start with CPAP first and add the nitro gtt later if needed.

If the patient is compensating nicely (and apparently is) and doesn't decompensate when I sit him/her down on the gurney, I'm just going to give a nice & comfortable ride over to the ED and let them figure out this patient's problem.

 

[Brandon O]

Could be TRALI. Seems a bit fast though.

 

[coolidge]

So how did this patient's care and diagnosis resolve?

 

[ABQmedic]

I can see getting rid of the lasix, but what's reasoning behind eliminating the NTG?

Oops. Time to eat some CROW. Our new protocols include NTG. My apologies for speaking before seeing the end product.:blush:

 

[medicaltransient]

No. Could be some kind of exudate due to cancer or increased WBC from cancer.