Submission ID: 119
If a Pt is found with Respiratory Distress, and is complaining of chest Pain, and meets all Criterias for Bronchoconstriction and Ischemic Chest Pain Directives, Which Drug should be administered first, Salbutamol or Nitro?. Our current debate is between: "Not harming the patient", give the Salbutamol first to see how his heart reacts, or "Do all you can for your Patient", and give the Nitro first, so that your Salbutamol can be administered regardless of the Patient current Pulse.
If a patient is to be treated under more than one medical directive, the more serious condition should always be first and guiding directive to follow.
Consider the possibility that wheezes in a cardiac patient may not actually be bronchoconstriction in the asthma sense, but may be the temporary presentation of pulmonary edema (“cardiac asthma”). It was stated in past CMEs that if you think that it is bronchoconstriction, treat it with your bronchoconstriction drug (Salbutamol). If you think that it is pulmonary edema, treat it with your pulmonary edema drug (NTG). Be alert for possible changes, and change your treatments accordingly and document why on your ACR. That being said, exercise caution when giving Salbutamol to a cardiac patient. Excessive doses may have alpha or Beta-1 side effects that are detrimental to cardiac patients, but judicious doses may improve oxygenation and reduce the work of breathing, both beneficial.