Concerns about a recent call

[dahlio]

I was dispatched to a woman not feeling good (I don't feel good a lot, however, dont call an ambulance for that :roll: ). Arrive to find a patient lying on the park bench, at a BBQ. Police on scene (trained first responders) have her on o2 via NRB at 6lpm.....anyway. I get a quick picture from him, and she says she's complaining of chest pain. Start my assessment, and find out she had taken Nitroglycerin, not prescribed to her. We ask for ALS, which arrives 5 minutes later. Prior to their arrival, B/P 98/72, pulse 88, diaphoretic, no trouble breathing, resps of about 16. Pain on a scale 1/10=5. Chest pain is not reproduceable upon palpation, and it's a tightning feeling, and does not radiate. Pain had been going on for 10 minutes prior to our arrival. Continue her on NRM at 10lpm. Load her in to the ambulance, as medics hop in ours. They hook up the monitor, and get a BP of 152/108. After a 12-lead, they say it's sinus rhythm. 5 minutes later, repeat B/P of 112/88. The medics give her baby aspirin, as a precaution. We get one more repeat BP before going in to the ER of 96/68. Pain is 1/10=2/3.

I was so confuse after this call. Were the crazy BP's just a result of the Nitro? Curious as to what people think this could have been. Thanks again, and if you need more info, or if i left something out, just let me know. Thanks for your responses.

[Dustdevil]

Lots of potential factors here. A twenty point difference between different arms on the same patient is not terribly uncommon. A twenty point difference between an auscultated BP and a machine BP is not uncommon at all either. That in itself could account for a great part of the differences without any physical abnormality. And you are on the right track with the NTG connection. We don't know how much she took or exactly when, so it's hard to tell. But profound drops are not an uncommon reaction to NTG, and neither are hypertensive rebounds to those drops.

[whit72]

Blood pressures are effected by everything. Alone you cant base a treatment on one pressure reading. There are to many factors which can effect them.

Like dust said could be the use of different machines. The hospital cuffs and the bp cuffs attached to the monitors need calibration which they rarely or never receive. At least in our area. Nothing compares to a manual pressure, or if you cant get one, if a radial pulse is present she has a systolic of at least 80 or so. You can learn a lot from simply taking a radial pulse.

The nitro is probably the most likely culprit. Always ask if there was a burning sensation under the tongue after the nitro is administered, that will be a good sign that it was still effective, and may be the reasoning behind the decrease in the systolic pressure.

[dahlio]

Thanks, had no idea the nitro could make a patient hypertensive like that, good to know. Thank you for your continued responses.

[Ridryder 911]

Thanks, had no idea the nitro could make a patient hypertensive like that, good to know. Thank you for your continued responses.

Actually, the NTG probably did not cause hypertension, rather the NTG had worn off and the patient's underlying pressure was hypertensive. The NTG probably caused the pressure to decrease.

R/r 911

[whit72]

I am not sure if you are confused.

NTG can cause hypotensive periods. (low blood pressure)

The dip in her systolic on your arrival was probably due to the NTG administration. Like rid stated. The effects had probably worn off by the time the medics arrived. Her systolic pressure would have returned to normal or slightly elevated like you explained.

[Chief1C]

Often, even if you reassure the hell out of a patient, they get hypertensive because of their environment. Medics, needles, big words, etc. May just have been upset, some people see more medical personnel arriving or medics, and assume the worst.

[medic001918]

...Police on scene (trained first responders) have her on o2 via NRB at 6lpm.....

Many others have answered your questions already. But I hope this is either a typo, or the first thing you corrected on scene? A mask at 6 LPM is not acceptable and can cause other problems.

And what is "1/10=2/3" Is that a 1-3 on a ten scale? Just trying to get a complete picture of this call.

Shane

[dahlio]

Many others have answered your questions already. But I hope this is either a typo, or the first thing you corrected on scene? A mask at 6 LPM is not acceptable and can cause other problems.

And what is "1/10=2/3" Is that a 1-3 on a ten scale? Just trying to get a complete picture of this call.

Shane

Yeah, hence why I put the amount of lpm. I kind of looked at the cop funny when transferring over to our bottle. Yeah it's a 2 and a half out of the ten scale. Sorry about the confusion, hopefully that clarified it up for you. I also stated in my original post that I continued her o2 therapy via NRM (should have been NRB, typo on my part), at 10 lpm.

[dahlio]

I am not sure if you are confused.

NTG can cause hypotensive periods. (low blood pressure)

The dip in her systolic on your arrival was probably due to the NTG administration. Like rid stated. The effects had probably worn off by the time the medics arrived. Her systolic pressure would have returned to normal or slightly elevated like you explained.

Not confused about the fact that her B/p would drop after taking NTG. It just sounded like that when it wore off, it actually made her hypertensive afterwards. The NTG would explain the low B/P the first time around, but what I'm really curious as to why she shot up in to the 150 range, and then lowered again by the time we got to the hospital, without more administration of NTG. Maybe she was just that anxious, but she was keeping it inside...no idea. Thanks again.