Nitro / IV

[Guest guest]

At 02:25 PM 3/28/2004, you wrote:

>I had a patient with chest pain but had no IV access upon arrival at the

>emergency room the DR on duty asked why we had not treated the patient

>with Nitro

>I advised him that without an IV we could not give the patient Nitro, And he

>stated we prescribe nitro for millions of people and the give themselves

>Nitro

>at home without an IV, And the Paramedic's who are the professionals have to

>have an IV first he shook his head and asked me to go and get my Nitro spray

>and while the were getting a bed ready for the patient to start giving the

>patient Nitro every 5 min untill a room was ready for the patient.

Many of the local protocols I am familiar with are straying from the

mandate of IV must occur before nitro. The importance of Nitro far out

weighs the small chances of hypotension.

Jim<

[Guest guest]

I agree with 100%. Further, on the subject of NTG, there are great

studies that show that in pulmonary edema of cardiac origin NTG is the drug of

choice, over Lasix and MS.

There's an excellent summary of CPE at:

http://www.emedicine.com/MED/topic1955.htm

With pulmonary edema patients, we should be thinking NTG.

GG

In a message dated 3/28/2004 8:34:18 PM Central Standard Time,

cwblum@... writes:

The only real risk in administering NTG without an IV line lies in

complicated Inferior MI or RVMI. This is a small to moderate

percentage of the people that we treat. Evaluation for both can be

performed in the field with even a 3 lead ECG. Although, if a

patient uses NTG at home on a regular basis, it is typically acceped

practice to assume (yes, I know assumption is a risky business)that

the patient will not respond in a negative manner to the NTG without

an IV. If the patient does not present with hypotension, or ECG

changes in Lead II, III, and a Modified Chest Lead V4R (with a 3

lead ECG) or II, III, AVF, and V4R (with a 12-lead ECG), then I

would feel totally comfortable giving NTG without an IV line. I

know that standard practice for our Basics (when running a BLS

truck) at the services I worked for was for them to give NTG

regardless of the absence of an IV line. The physicians I have

always worked for have preferred for an IV line to be present before

NTG administration, however, they always wanted NTG administered if

an IV line was not obtainable, UNLESS there were changes that would

indicated RVMI. If there are no contraindications to the NTG (any

of the many impotence drugs, i.e. Cialis, Levitra, Viagra, etc.,

RVMI, or other) then NTG should be administered regardless of IV

line presence. You would only be making things worse by witholding

it unnecessarily.

W. Blum, EMT-P/CCEMT-P/EMS-Instructor

[Guest guest]

I agree with 100%. Further, on the subject of NTG, there are great

studies that show that in pulmonary edema of cardiac origin NTG is the drug of

choice, over Lasix and MS.

There's an excellent summary of CPE at:

http://www.emedicine.com/MED/topic1955.htm

With pulmonary edema patients, we should be thinking NTG.

GG

In a message dated 3/28/2004 8:34:18 PM Central Standard Time,

cwblum@... writes:

The only real risk in administering NTG without an IV line lies in

complicated Inferior MI or RVMI. This is a small to moderate

percentage of the people that we treat. Evaluation for both can be

performed in the field with even a 3 lead ECG. Although, if a

patient uses NTG at home on a regular basis, it is typically acceped

practice to assume (yes, I know assumption is a risky business)that

the patient will not respond in a negative manner to the NTG without

an IV. If the patient does not present with hypotension, or ECG

changes in Lead II, III, and a Modified Chest Lead V4R (with a 3

lead ECG) or II, III, AVF, and V4R (with a 12-lead ECG), then I

would feel totally comfortable giving NTG without an IV line. I

know that standard practice for our Basics (when running a BLS

truck) at the services I worked for was for them to give NTG

regardless of the absence of an IV line. The physicians I have

always worked for have preferred for an IV line to be present before

NTG administration, however, they always wanted NTG administered if

an IV line was not obtainable, UNLESS there were changes that would

indicated RVMI. If there are no contraindications to the NTG (any

of the many impotence drugs, i.e. Cialis, Levitra, Viagra, etc.,

RVMI, or other) then NTG should be administered regardless of IV

line presence. You would only be making things worse by witholding

it unnecessarily.

W. Blum, EMT-P/CCEMT-P/EMS-Instructor

[Guest guest]

The only real risk in administering NTG without an IV line lies in

complicated Inferior MI or RVMI. This is a small to moderate

percentage of the people that we treat. Evaluation for both can be

performed in the field with even a 3 lead ECG. Although, if a

patient uses NTG at home on a regular basis, it is typically acceped

practice to assume (yes, I know assumption is a risky business)that

the patient will not respond in a negative manner to the NTG without

an IV. If the patient does not present with hypotension, or ECG

changes in Lead II, III, and a Modified Chest Lead V4R (with a 3

lead ECG) or II, III, AVF, and V4R (with a 12-lead ECG), then I

would feel totally comfortable giving NTG without an IV line. I

know that standard practice for our Basics (when running a BLS

truck) at the services I worked for was for them to give NTG

regardless of the absence of an IV line. The physicians I have

always worked for have preferred for an IV line to be present before

NTG administration, however, they always wanted NTG administered if

an IV line was not obtainable, UNLESS there were changes that would

indicated RVMI. If there are no contraindications to the NTG (any

of the many impotence drugs, i.e. Cialis, Levitra, Viagra, etc.,

RVMI, or other) then NTG should be administered regardless of IV

line presence. You would only be making things worse by witholding

it unnecessarily.

W. Blum, EMT-P/CCEMT-P/EMS-Instructor