Nitrolingual

[EMS49393]

Wow, and people think I inspire arguments. I'm just curious why you would ask a question on a forum, only to make a valiant attempt to debunk it and try to prove everyone (that took time out of their day) wrong? I completely agree with Dust's explanation on the preferred route of administration of NTG. The very thin membrane and immense vasculature makes a sublingual administration of NTG not only work better, but work faster. I won't go into what degree I have, since it only serves to make people think I am arrogant because I chose to obtain an education.

Personally, I prefer to put my NTG on a pump and titrate to effect, especially when dealing with a RVI. I can start off small, hopefully offer some relief, and have better control over the medication.

[Ridryder 911]

Here ya go! Anyone been in EMS more than a couple of weeks knows that NTG spray in the first spray usually mists and does not come out readily. But, I am sure your "mentor" already discussed that as well as the high rate of conjunctivitis that is associated with NTG spray because of the above problem.

As a REAL Critical Care Paramedic and Critical/Emergency RN, I can assure you I probably have given more NTG in more multiple forms in one month, than most medics has performed in a year. As well, as one that routinely does administer NTG bucosal mucosa, I do not usually give it sublingual & definitely not on the tongue. Yes I use the the bucosal mucosa method ( pull the cheek outward and spray into the cheek gum area (y-e-s it is called bucosal but still considered a mucosal membrane) just like in your rectum. Like the above post, usually either I adminster it per IV or paste method.

Bet you never read a blog or maybe an insert that you are supposed to have the patient rinse their mouth after NTG per bucosal/sublingual mucosal either? But, you already knew that too.... :wink:

As far as going back to school, I was not the one that thought administering NTG was a spectacular event!

R/r 911

[Scaramedic]

I like 2" paste on the chest.

I have actually sprayed so much NTG on a transport I even got a headache. I also agree you always spray it once before you spray it in your patient.

[mobey]

Bet you never read a blog or maybe an insert that you are supposed to have the patient rinse their mouth after NTG per bucosal/sublingual mucosal either? But, you already knew that too.... :wink:

R/r 911

Sorry to interrupt...But I would like to learn something positive here. Rinse thier mouths ..Really?

Why?

I have never heard of that before.

(And I do administer my Nitro SUBlingual, I think that was in the first week of PCP school hehe)

[gvandellen]

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.

[mobey]

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.

Well I consider myself and co-workers to be in the late 90's early 2000's, and no, I have never heard of it. I have taken 2 going on 3 university A&P courses (not degree) and feel I have a decent understanding of how absorption works.

So it is my Opinion that the lack of vasculature combined with a thicker membrane would make absorption slower through the top of the tongue. Also since the nitro spray would have to "sit" on the top longer there would be a better chance of it being washed down the esophagus or inhaled.

I work with veteran Paramedics, Newbie Paramedics, and students and have never seen this done. so my answer is no, this is not a standard practice and I don't think it would be a good idea to start.

[Dustdevil]

The company says it doesn't matter.

You are intentionally misquoting the manufacturer, as well as intentionally ignoring the context of their advice. Poor debate form.

If it doesn't matter then why do we fight with the patient to spray it under the tongue.

Since you FAIL to provide a link, I doubt that any of us have read this blog you're so impressed with. But what is all this nonsense about "fighting" with patients to raise their tongue? First, I have never in three decades had to fight with anybody over it. And second, anybody who lacks the capacity to lift their tongue is probably not a good candidate for NTG anyhow. Since you admit that this entire concept is new knowledge to you, then really, how much experience could you possibly have "fighting" with patients over raising their tongue? And were you even practising in the days of NTG tablets?

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.

You have been told both ways. And you were so impressed with hearing about the sublingual route that you just had to run here and tell us all about it. That's why we are perplexed why now, all of a sudden, you have changed your mind about what an earthshaking revelation it was? Is this just an attempt to baffle us with bullshit since you FAILED to dazzle us with brilliance? Seriously, dude, I just don't get what your point is.

I don't care how....let the scientists figure it out.

In other words, "I'm no medical professional. I'm just a tech school monkey medic. All I care about is my protocols, so don't confuse me with all that physiology and pharmacology nonsense." Exactly what I figured. And exactly why you get no love from anybody in this thread.

And you really think you ought to be cut loose from medical control? :roll:

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.

So, if your mentor has twenty years of experience, he's Asclepius, but anybody with fifty percent more experience and ten times the education is cluelessly stuck in the 80s?

Get lost, dude. We already answered your questions, and you weren't professional enough to digest it. You didn't come here looking for intelligent medical discussion. You came here looking for drama. Don't further embarrass the state of Pennsylvania with this idiocy.

[Scaramedic]

And were you even practising in the days of NTG tablets?

The only problem with the tablets was getting the patient not to chew them. One of my Paramedic instructors use to tell his patient the nitroglycerin would explode if they chewed it. :shock:

Thanks for the new sig Dust.

[Scaramedic]

Here is why we give it SUBlingual.

Bioavailability is 59% after sublingual administration and 22% after oral administration.

From Drugs.com

In other words it is over twice as effective to give it SL than oral.

[akroeze]

Just thinking out loud (well, through my fingers).

You have a patient who is severe CHF to the extreme and semi-conscious from being so hypoxic. You want to give them nitro and assuming they meet all the V/S parameters how do you do it if they aren't coherent enough to lift their tongue? Do you lift it for them?

Just curious cuz I'm not sure.