Nitroglycerin administration with borderline VS
Question# 900
Hello, I have a question regarding Nitroglycerin. Assuming they meet all indications, conditions and have no contraindications, Say I give Nitro to a Patient and there originally BP was 120/80, and I go to give a second dose, and the BP is 101/60. Sure, this Pt is normotensive now and still indicated for Nitro, because the BP didn't drop by a 1/3, but it will likely drop the Pt into Hypotensive. Is it still worth to give an additional dose of Nitro, risking Hypotension, or is it still worth it. Also dose this change for those who are IV autonomous who get attempt to increase the Patients BP. (for Reference I am not IV).
Answer:
Coronary perfusion pressures are dependent on overall hemodynamic stability. The coronary arteries are largely perfused during diastole and maintaining adequate coronary perfusion is essential in the context of ongoing ischemia so as not to worsen the damage to the myocardium.
Paramedics are encouraged to use sound clinical judgment when providing patient care. It is reasonable to administer nitroglycerin if the patient remains within the parameters of the cardiac ischemia medical directive at the time of administration and the paramedic believes that any potential complications can be managed in the prehospital setting, as patient-centered care involves weighing the risks and benefits of treatment.
However, if paramedics anticipate a possible drop in the patient's blood pressure secondary to nitroglycerin use and they are not authorized to autonomously establish IV access, it is reasonable to withhold nitroglycerin, provided that the clinical reasoning behind this decision is clearly documented.
Another important consideration is the effect of the medication on the patient’s symptoms. If nitroglycerin is clearly improving the patient’s discomfort, that supports continued dosing, provided it is not contraindicated at the time the next dose is being considered. On the other hand, if there is no relief after the first dose, it may be reasonable to re-evaluate the benefit of administering further doses.
The ALS PCS preamble supports paramedics withholding treatments based on sound clinical decision making provided adequate justification is recorded on the ACR. Making an OMC call is also always an option to discuss your clinical decision making.
Paramedics are encouraged to use sound clinical judgment when providing patient care. It is reasonable to administer nitroglycerin if the patient remains within the parameters of the cardiac ischemia medical directive at the time of administration and the paramedic believes that any potential complications can be managed in the prehospital setting, as patient-centered care involves weighing the risks and benefits of treatment.
However, if paramedics anticipate a possible drop in the patient's blood pressure secondary to nitroglycerin use and they are not authorized to autonomously establish IV access, it is reasonable to withhold nitroglycerin, provided that the clinical reasoning behind this decision is clearly documented.
Another important consideration is the effect of the medication on the patient’s symptoms. If nitroglycerin is clearly improving the patient’s discomfort, that supports continued dosing, provided it is not contraindicated at the time the next dose is being considered. On the other hand, if there is no relief after the first dose, it may be reasonable to re-evaluate the benefit of administering further doses.
The ALS PCS preamble supports paramedics withholding treatments based on sound clinical decision making provided adequate justification is recorded on the ACR. Making an OMC call is also always an option to discuss your clinical decision making.