Nitro/BLS

[James_ffemt]

I was just wanting some input on what everyone thinks about EMT-B's giving nitro. Here in Oklahoma Basics are not allowed to start IV's. It has been mentioned to me that it is a good idea to have a line established when administering nitro in case bp decreases. You guys give your opinion on nitro administration with and without a line established.

[dahlio]

Basics in NJ can assist with nitro, not give it. Have to check for contraindications, and make sure of the 5 rights. Right patient, right dose etc. Also in NJ need to have a Systolic B/P of 110 in order to give nitro to them, same goes for ALS in NJ, if they are going to give them Nitro.

It has been mentioned to me that it is a good idea to have a line established when administering nitro in case bp decreases.

And do what with it? Wait for ALS? I'm only a basic, and as much as that Saline Lock of Life cures everything, I don't think it's going to raise your pt's B/P. I don't see any reason to have to start an IV. ALS is usually dispatched along with Chest Pain, and if not, should be requested since Basics can't/don't know how to use the little squiggly line machines .

Just my 2 cents..

[tskstorm]

and as much as that Saline Lock of Life cures everything, I don't think it's going to raise your pt's B/P.

Are we certain that ALS cant give medications to raise the patients blood pressure?

The reason for needing a line established is not for the " Saline Lock of Life" but for access to administrate medication to raise the blood pressure.

[dahlio]

Understood, but as a basic starting an IV line, you won't be pushing any drugs to raise the pt's b/p, so what's the point of the basic starting the IV line?

I'm not saying the IV is unnecessary for ALS, but there is no need for BLS to start a line.

[Dustdevil]

I guess you could make the argument that, by establishing an IV, you make it a little bit easier for the paramedic intercept unit to save your arse after you darn near kill your patient through stupidity.

[dahlio]

I guess you could make the argument that, by establishing an IV, you make it a little bit easier for the paramedic intercept unit to save your arse after you darn near kill your patient through stupidity.

Yeah, but when the basic screws it up, and doesn't get in to a vein (due to lack of training/education), it will take more time for the paramedic to pull that one out, and start a new one.

[Ridryder 911]

I was just wanting some input on what everyone thinks about EMT-B's [s:31c2a54e1e]giving nitro[/s:31c2a54e1e]. Here in Oklahoma Basics are not allowed to start IV's. It has been mentioned to me that it is a good idea to have a line established when administering nitro in case bp decreases. You guys give your opinion on nitro administration with and without a line established.

Actually, in Oklahoma, they are allowed to assist in giving NTG. If the patient has NTG it is presumed that they have angina, hence this maybe what the cause is. Again, many people do not have IV's in place and perform administration quite well by themselves.

Now, the problem arises as it has been mentioned multiple times is those that are NOT having angina, rather are having a TRUE AMI and even one that is located in an area that NTG could be harmful.

I am not in favor of any basic administering any medication. This being from ASA to NTG to nebulizers, rather I much rather the education focus on vital signs, history taking and assisting medics on a cardiac call, as first responders.

Permitting Basics to establish an IV would be of no value for those that was administered NTG, since they again would not be able to determine or distinguish the underlying cause or etiology.

R/r 911

[ERDoc]

Haven't we beaten this dead horse several times already? :banghead:

:director: The search function is your friend

[James_ffemt]

Ok, I'm not saying that I want basics to start IV's or give medications. Just want opinions on if you think it's better to have a line established in case the nitro drops the bp. We are allowed to give nitro after checking for contraindications. My concern is, why the hell do I want to give a medication that could potentially kill the pt if their bp drops and I have no way of getting it back up like paramedics do. I understand calling for ALS if it's a cardiac call but ALS is not always available. Again, I am looking for further knowledge on what you guys (paramedics) would rather see when nitro is delivered. (IV established or not) and why.

[DwayneEMTP]

Ok, I'm not saying that I want basics to start IV's or give medications. Just want opinions on if you think it's better to have a line established in case the nitro drops the bp. We are allowed to give nitro after checking for contraindications. My concern is, why the hell do I want to give a medication that could potentially kill the pt if their bp drops and I have no way of getting it back up like paramedics do. I understand calling for ALS if it's a cardiac call but ALS is not always available. Again, I am looking for further knowledge on what you guys (paramedics) would rather see when nitro is delivered. (IV established or not) and why.

At the time the nitro is delivered, it is certainly preferable to have a good IV started. No question about it. Why? Because a patent IV gives advanced options if things get squirrely.

No different than playing with fire. If you have the option to have a hose nearby in case things go sideways, wouldn't it be reckless to ignore it?

And if you find there is no hose to be had...would you still choose to play with fire?

You've asked a good question, this is exactly the way you should be thinking.

'Why' and 'what if' being constantly in the front of your mind is what will separate you from the great unwashed masses.

Thanks for posting!

Dwayne