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Nitro admin and Inferior Wall MI

Question #: 361

Question:

Just recently did an inferior MI pt with ST elevation in II, III and avf with reciprocal changes to V3 to V6. We did a 15 lead by putting v4 on the right side and it was negative. His pressure was systolic 160 . I gave the pt so e ASA but was confused if Nitro should of been given therefore I didn't give any. We were both PCP . Should Nitro be given if the 15 lead is negative? And follow the STEMI protocol?

Answer:

The Cardiac Ischemia Medical Directive parameters are designed to ensure quality and patient safety, even for PCPs.

Assuming you have IV access or there's previous history of nitro use, if the patient has elevation in II, III, aVF with reciprocal changes and NO elevation in V4r, the heart rate is 60 or more, and the systolic blood pressure is 100 or more; it is appropriate to administer nitro. V4r acquisition, blood pressure and heart rate values should be obtained and interpreted prior to each nitro administration to ensure you adapt your management plan to your findings.

Specific to the situation you presented, if the patient is STEMI, there's no elevation in V4r and the systolic blood pressure remains above 100, you would be able to administer up to 3 nitro doses. If, at any point, your heart rate drops below 60, your systolic blood pressure below 100 and/or you have elevation in V4r, you would discontinue nitro to prevent an adverse event.

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