gvandellen

I don't want this to be an argument. I just want to know if people read the insert with the Nitrolingual spray that says it can be given under or over the tongue and if it was an reasonable alternative for EMS. If it works the same then the protocols need to be updated to adjust for spray to be given on the tongue. Has anybody given it on the tongue or read the insert?

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

This isn't a discussion on NTG though....This is a discussion on NTG Spray. I am not disputing the fact that the sublingual mucosa isn't the best route for NTG sublingual tabs gvien under the tongue or IV Nitro given IV or NTG Paste given on the skin. This post is about NTG spray given under or over the tongue. The company says it doesn't matter. If it doesn't matter then why do we fight with the patient to spray it under the tongue. I don't care how you give it!!! As Dust says spray it it their ear it's your patient but I have been told that the effects are the same either under or over the tongue. I don't care how....let the scientists figure it out. If it works then do it. I'm just trying to find out if anybody not stuck in the 80's and in a progressive EMS system has heard of this.

Do you have a degree in A&P Dust? Do you know the absorption rates of buccal vs sublingual tissue? Is it different? The same? Does it matter it 3 to 5 minutes between doses? Maybe you give the spray under the tongue because your director doesn't know the difference, maybe he doesn't care? Have you asked him? This isn't supposed to be a pissing match? You've been a medic for 35 years? So what? Medicine changes daily! I only link to that website as a general guideline but the product package insert states it as well. I'm just passing on information from the manufacture that I found based on information during my instruction. The great Dust doesn't know all or we'd all be attending your lectures for standing room only. The only thing you've confirmed is that what I learned was wrong by your statements not the ideal way. I've read them and you quote.. "The proper route of administration for Nitrolingual is -- and has always been -- sublingual. You can and will get some effect from spraying it on the palatine surface of the tongue, but that is not the ideal or recommended route." Says who? You? Your protocols? Your A&P teacher you had 35 years ago? What does the tongue have to do with it? Did I even say it would be absorbed by the tongue?

Just where is the nitro going to bounce off to??? I've never seen mist bounce? Ridryder buccal administration is a proper route for drugs. Nicotine gum is made like this. Chew and stick back in cheek every minute. Might be time to go back to school.

Wow, a bold statement to insult a 20 year medic that you don't even know...We have a fantastic medical director that even went to the state and asked for our medics to bypass contact medical command boxes because we can actually think as healthcare providers and to only contact them if a treatment isn't working. Can your system say the same? Our medics were taught this from the medical director with information also obtained from the AHA so apparently the patients are getting relief. Look at the package insert on the product Dust and it says... "...spray onto or under the tongue." and ..."preferably onto or under the tongue." See http://www.drugs.com/pro/nitrolingual.html Either way IS the proper route of administration... Buccal mucosa is just as absorbent and the only reason we put the Nitro tabs under the tongue is it stimulates saliva production to spread the Nitro around the mouth which the spray doesn't need.

I was reading Street Watch: Notes of a Paramedic the other day as usual he had me laughing my A$$ off about getting people to lift their tongue up to spray Nitrolingual however my mentor said that you just spray it in the mouth on the tongue. I hadn't thought about it since he just told me last week but I mentioned this on the blog and sure enough PC found it to be true. Has anyone else heard about this?

Old problem new hype....I'm 34 and I was drinking Robi DM when I was 18. Do the math. It's nothing new and most people don't OD on DM.

The only thing Fill in Forms are good for is when you need to write a PCR hours later and not as an official doc. They go in the shredder when the real PCR is done.

Hmmmm...One guy, one cup, and a freak on a toilet with wet hair? Just waiting for the website now :twisted:

This is why I love our planet... You think you heard it all and then something like this pops up. Human beings are great!!!

The call volume was high, I ran roughly 350 calls in 20 days. A lot of BS but we did have a lot of sick patients as well. There were a lot of patients that should have been treated on scene. 13 other students felt the same way. Why aren't we treating these patients quicker? I'm not bashing city style but I'm curious as to why it's gotten like this? Don't get me wrong my preceptor was smart and if I got hurt I'd want him. Good points by everyone though to think about. I just want the best for EMS and for the future students that do their time in Philly.

I spent 3 months in Philly doing ride time and now I work 911 in a suburb of the city that has as much crime, poverty, and call volume per capita as the city. The only difference is we treat patients before we leave the residence. Why? I never started a treatment for asthma on a city pt because we never brought in o2. My precepts said we work out of the truck in our environment. Now as a medic right outside the city I have to remind myself that I'm not in the city and we treat pt's before we transport them to a hospital? Is this burnout, laziness, or an overworked system for city EMS workers? My first few weeks in the suburbs I wanted to walk pt's out to the truck but my mentor had me actually treat a pt on scene. I have to be reprogrammed to treating a pt and I find that sad. I have had 3 CHF pt's and all had no resp distress on arrival to the hospital. 3 minutes to scene, 10 on, and 3 min transport vs 3 minutes to scene, walk pt to truck, increase SOB, start treatments, sit by charge RN trying to get a bed for a pt in distress. Aren't we sent to help pt's not transport? Why is city EMS so different? Does having a distressed pt help you get a bed quicker so you can clear your call? This isn't to attack city EMS, I understand your call volume, Philly even added more units to handle the call volume, I just want to know if you feel you are actually turning distressed pt's around vs just stabilizing them for entry to the ER.

Sort of sad, The MD gives a treatment, pt clears and they leave, paramedics give a treatment and we have to transport to be cleared. How many CHF patients treated at home by EMS are clear by the time they hit the ER stretcher?

How important are allergies to you as a pre-hospital provider? I ask this because as I was thinking that our DL only says that we are a organ donor? Would it benefit society to have allergies or certain information like diabetic printed on their DL? I don't want to get into a discussion on HIPPA and right of privacy on this and how the DMV would be involved and how it would need to be approved to get printed on a license. I've thought about that. I'll give you a quick scenario. PD pulls over someone because they are swerving from lane to lane. PD pulls the person over and they are compliant at first. They give their LIC but the officers gut feels like they are DUI because of the erratic driving? The person gets defensive and now the person is off to jail. Given that scenario do you think that PD having this information and them seeing that the person is diabetic they should then dispatch EMS to find the person BGL is 25? Would you look one more place for info on a patient? Examples if your not familiar: ICE on the cell phone directory...In Case of Emergency line The Bracelet/Necklace... Car Seats with info on the child on it.... I'm not talking Big Brother watching? Chip in the arm....just information that may kill them in the real world.