How risky is nitro without a line?

[spenac]

If you give a pt.sl nitro without an IV you run into the possibility of the pt having an allergic reaction to the med then you may run into some even more serious reactions and there hole system may shut down and you wont be able to get a line started at all.I think that it is best to get that line in first after O2 and ecg ect. because you might have a person that has no coronary history and has never taken it before and its better to have it and not need it then it is to need it and can't get it !!

IO?

[flopeyeman]

Good point!

[IslandEMS]

With the 12/15 leads now in many rigs it is easier to find those right sided MI's and steer away from the Nitro with out a line. My question for the pathophysiology junkies out there is; Is it likely to have a right sided MI with a Systolic BP >100? If the BP would be <100 with a Right sided MI isn't it safe to give Nitro for the chest pain the pt is having with a higher BP and no need to use a 12 lead to rule out the right MI? Giving it to the pt without a IV and Monitor would then be an OK basic skill.

[medic001918]

While one of the signs of an MI involving the right ventricle is hypotension, they don't always start with the hypotension. The safest bet is to attempt to determine the location of the MI before giving a medication that may increase the size of the infarct. We have to be cautious every time with regard to a patient that may be presenting atypically. The general rule of a BP of 100 being the "safe" number for NTG administration is a judgement call. There are patients that generally don't appear well with a BP like that due to a relative hypotension. You have to take into consideration the patients entire history and story with regard to the event before giving any medication. On top of that, with 12-lead EKG's becoming a standard of care there is no reason for a patient to not receive one to ensure they are getting the best care possible.

With regard to basics giving NTG based on BP, I would be hesitant. The biggest reason is that some people are more sensitive to NTG than others. I've seen people not have any BP change with NTG; and at the same time I've seen patients that have had substantial drops in BP. As a basic, should their pressure drop you have no way to correct the problem. More importantly though, you can't visualize if the damage may have been caused by your medication. The 12-lead is your safest means to ensure appropriate care. Anything less, and corners are being cut.

Just my two cents.

Shane

NREMT-P

[kevkei]

IO?

Sure, start an IO to save your a$$ as well as the patients, or how about an EJ or central line while we are at it? Now not only are they hypotensive and their ischemia/injury worsening because of it, they also have osteomyelitis and/or bacteremia from an invasive procedure. What about the simple philosophy that an ounce of prevention is worth a pound of cure? Absolutley it can be said that if your patient bottoms out, we can do something about it and respond appropriately, but you shouldn't be there in the first place. It's called putting the cart before the horse IMHO.

Speaking of 12/15 leads, what about the 50+% of MI's that are NSTEMI's? Your diagnostic tool that you depend on to screen goes out the window and is potentially useless.

[flopeyeman]

good point also just remember treat your pt. and not the monitor

[spenac]

Sure, start an IO to save your a$$ as well as the patients, or how about an EJ or central line while we are at it? Now not only are they hypotensive and their ischemia/injury worsening because of it, they also have osteomyelitis and/or bacteremia from an invasive procedure. What about the simple philosophy that an ounce of prevention is worth a pound of cure? Absolutley it can be said that if your patient bottoms out, we can do something about it and respond appropriately, but you shouldn't be there in the first place. It's called putting the cart before the horse IMHO.

Speaking of 12/15 leads, what about the 50+% of MI's that are NSTEMI's? Your diagnostic tool that you depend on to screen goes out the window and is potentially useless.

If possible IV first I agree but mentioned IO as a reminder that we can still get access.

[kevkei]

If possible IV first I agree but mentioned IO as a reminder that we can still get access.

Gotcha! I agree, if the ship hits the fan, it is a valid option (as long as it is available to you). I would just hate to have to do it if it was I that screwed up. :oops:

[spenac]

Gotcha! I agree, if the ship hits the fan, it is a valid option (as long as it is available to you). I would just hate to have to do it if it was I that screwed up. :oops:

Definitly tuffer than just taking time to start IV, but even new acls standards are having IO's come in to play after fewer IV attempts.

[AZCEP]

Definitly tuffer than just taking time to start IV, but even new acls standards are having IO's come in to play after fewer IV attempts.

That is a significantly different scenario than giving someone a NTG prior to IV access. Using a little forethought would prevent the problem, or the necessity of needing the IO in the first place.