NTG and IV's

Jon

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Question for all ALS (and wannabe ALS) providers.

Can you / Do you administer SL NTG without IV access established?

Is this with / against protocol?

remember... Pt's self medicate, and rarly have IV access in case something goes wrong. BLS can assist, and cannot give IV fluids....
 

usafmedic45

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As our medical director put it, he would strongly prefer us to get IV access first- especially if there is a borderline BP or if there is evidence on the 12-lead EKG of RV involvement. But the protocols don't demand IV access prior to NTG administration.
 

TTLWHKR

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I haven't worked as a "paramedic" in six years...

So I don't remember much. But I do recall IV before nitro, unless the patient is hypertensive.
 

Ridryder911

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I usually play it safe & start one, just in case the pressure does drop. I now prefer to see if they are having an inferior or right side involvement, AMI.
It all depends on teh situation, we allow people all the time to self admin. NTG without IV's...

Be safe,
Ridryder 911
 

rescuecpt

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If I can't get an IV in place, I call for orders for NTG w/o IV.
 

vtemti

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Vermont protocol is patent line first, but Med Control can overide if needed.
 

ECC

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Originally posted by rescuecpt@Jun 21 2005, 08:25 AM
If I can't get an IV in place, I call for orders for NTG w/o IV.
Gotta call?



















hmmmm.






;)
 

Summit

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BLS is not required to start an IV before NTG assist... but I most certainly establish an IV.

Our ALS is not required to have IV access either. I think most of them do though.
 

TTLWHKR

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Our instructor was bad. Very bad, he gave us the verbal "omg the guy is gonna die" kit.

1. Act First
2. Pretend to call command
3. break cell phone
4. break radio
5. lie

He's not a p-med tech instructor anymore.
 

TTLWHKR

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forgot to mention.. he described this as what to do when you act out of instinct, and not by protocol. Say you are out of cell phone range, the radio did not work, and it was your last best effort.
 

shorthairedpunk

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IV is Suggested, but not reqired if BP is over 100 or 110, i forget which, I generally have IV access in a case with CP thats going to be transported, mainly for the sake of the blood draw.
 

emtal233

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Usually need an IV prior to the administration of NTG, but if the pt has his or her own NTG and the pressure stays above 120 you can assist with their without and IV.... :blink:
 
OP
Jon

Jon

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Ok.

the service that I'm playing in... not 100% sure of official protocol, but Medical Director sez that 0.04mg SL Nitro Spray q3 min x3, systolic >90, with or without IV for total relief of C/P... then protocol sez we can give up to 4mg MSo4 IV slow push, titrated to pain relief...

I think that, at least the first NTG should be given before IV, so long as pt. is normotensive.

Jon
 

Firechic

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Per protocols: IV established and 12 lead ECG prior to administration of NTG to rule out inferior MI with RV involvement.
EMT-Bs are not allowed to assist with NTG per medical director.
 

Flight-LP

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Performing a 12 lead first is crucial and should always be done prior to nitrate administration. Personally, I'll give the first dose prior to an IV and then establish access to allow for other IV interventions (IV nitrates, Lopressor, MS4, etc.). Fortunately the good thing about NTG is "quick in, quick out". Hypotension secondary to NTG is usually self correcting within a short time and can be quickly reversed with minimal fluid..............
 

coloradoemt

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This is a good subject as I just watched a fire medic get his *** chewed by an ED doc for NOT starting a line first a couple of weeks ago. This Doc is also our medical director. I hear the argument all the time that the patient gives themselves NTG without a line but I feel it is crap. We arrive on scene to do everything in our power to assist our pt's and help the through their time of need. We are to take all precautions to assure that we do not harm them or make their situation worse. So with that said I personally will not put any of my patients in harms way simply because in the past I have never had a pt's bp crash after an NTG admin. You will never find me telling a Doc that I did not feel it necessary to take a couple of extra minutes to start a line.
 

wackermedic

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Ou rprotocols here in SE Pennsylvania one region I work in is NTG with a systolic B/P 110, IV recomended. Another is 90, IV recomended. So I guess in the area of 100. I like to have an IV. Ever see somone bottom out on NTG? If I have a good access site I will give the NTG while startign the IV. If it is goign to be a hard stick and the pt takes the NTG all the time and the B/P is good I will if not I wait until I have access. Can't wait for the statewide protocols. Be safe and have a great day.
 

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