Improved outcomes from nitro

[Dustdevil]

...nitro is likely worth doing, give it if you've got it, but not something you'd call a high priority, and certainly don't give it in preference to other care (such as ASA).

Especially since Morphine and Fentanyl are cheaper, more beneficial and less risky.

Most prudent practitioners will still maintain that it should not be given at all without already having an IV and a 12 lead completed. The first time you actually cause someone to go into cardiogenic shock by carelessly administering NTG, you'll remember that mistake for the rest of your career... assuming you still have a career.

Edited February 20, 2010 by Dustdevil

[rock_shoes]

Yeah I definitely agree that it is worth giving, although with no proven benefit you might want to be cautious with its use under some circumstances. Funny enough, they are actually giving Viagra to people (including women) with pulmonary hypertension!

All the more reason it's important to ask about a patient's medications prior to administering medication if at all possible. Taking a proper and accurate patient history has a tremendous affect on patient outcomes. That's one of the biggest reasons I'm such a proponent for education. If you don't understand what body systems are likely being affected given a patient's signs and symptoms how are you going to know what questions to ask or even what to do with the answers? If you don't have an understanding of pharmacology how are you going to know which medications you can or can't use on a particular patient? Every individual is different making "one size fits all" protocols far from best practice. "Monkey see, monkey do" just isn't good enough anymore. Really, it never was good enough. It was just all we had.

The use of Sildenafil in the treatment of pulmonary hypertension is an interesting development by the way. Do you have access to any research papers that could be shared with the rest of us?

[Brandon Oto]

Especially since Morphine and Fentanyl are cheaper, more beneficial and less risky.

Most prudent practitioners will still maintain that it should not be given at all without already having an IV and a 12 lead completed. The first time you actually cause someone to go into cardiogenic shock by carelessly administering NTG, you'll remember that mistake for the rest of your career... assuming you still have a career.

Which raises the issue of whether you should give the nitro if circumstances (short transport, limited hands, difficult access) make getting a line or your 12 lead impossible. My feeling is definitely not without the ECG (too great a risk of right ventricular infarct) and, in light of the previous discussion of the marginal benefits of the nitro, probably not without the line. Although if you're comfortable and a gunslinger with something like the EZ-IO this may not come up much.

[Levi]

All the more reason it's important to ask about a patient's medications prior to administering medication if at all possible. Taking a proper and accurate patient history has a tremendous affect on patient outcomes. That's one of the biggest reasons I'm such a proponent for education. If you don't understand what body systems are likely being affected given a patient's signs and symptoms how are you going to know what questions to ask or even what to do with the answers? If you don't have an understanding of pharmacology how are you going to know which medications you can or can't use on a particular patient? Every individual is different making "one size fits all" protocols far from best practice. "Monkey see, monkey do" just isn't good enough anymore. Really, it never was good enough. It was just all we had.

The use of Sildenafil in the treatment of pulmonary hypertension is an interesting development by the way. Do you have access to any research papers that could be shared with the rest of us?

I saw a woman with scleroderma / systemic sclerosis who an attending prescribed it to a few months ago. Here's a NEJM article about it, but there's a lot more out there. http://nejm.highwire.org/cgi/content/abstract/353/20/2148