Pedal Edema vs. Chubby Ankles

[tcripp]

You don't want to pop the seal if possible as you'll promptly derecruit any alveoli you've gained.

I've been known on severe CHF'ers to dump the require 3 SL NTG under the tounge all at once and then move to a NTG infusion titrated quickly up to 50-100mcg/min.

No, we don't want to break the seal which is why I'm looking at alternative solutions.

Now, as to dumping 3 rounds of NTG at the same time, you are the second person to mention this as an option. While we have SL NTG by both spray and tablet, we do not have the infusion on board. But, we don't have a "max 3" limitation for CHF.

Question, when you've provided the 3 at once, have you ever had a problem with the BP tanking? Has anyone ever seen this as an issue?

[usalsfyre]

Question, when you've provided the 3 at once, have you ever had a problem with the BP tanking? Has anyone ever seen this as an issue?

If they're in badly decompensating (the folks with pressures north of 160/100, one word dyspnea, HRs of 130 or 140) it's pretty unlikely.

SL NTG absorbs at a rate of around 60mcg/min, so three of them is 180mcg/min. Over at the EMCrit podcast Dr. Weingart says he starts people at this level of distress off at 400MCG/MIN :eek:, quickly backing down to 100mcg/min when he starts to see symptom relief.