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EMS: Administering Nitroglycerin

Tue, 13 Mar 2012|

Mike McEvoy shares some tips on different way of administering nitroglycerin to patients and goes over some concerns for responders when giving the drug.

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Transcript

[BLANK_AUDIO] [MUSIC] [GLASS BREAKING]. Hi, welcome to training minutes. Today we're going to talk about the administration of nitroglycerine. nitroglycerine give to patients with chest pain comes in two different forms. We see nitroglycerine spray, that patients may carry, and we see nitroglycerine tablets. So I want to talk first about the spray. You give nitroglycerin spray by removing the oxygen device that's on the patient, taking the spray and spraying it under the patient's tongue. The important part about this is that we have a tendency to lean in towards the patient when we remove the mask and spray the nitroglycerin. And I want to show you for a second. What the nitroglycerine spray looks like when it sprays. [NOISE] That mist is all medication. If your face is near the patient when you spray the nitroglycerine underneath their tongue, you have a likelihood of inhaling the nitroglycerine and having the medication take effect on you, yourself. As well as the patient. Not a good idea. The other form of nitroglycerine is nitroglycerine tablets. Now we've taken the patients oxygen mask off and we're gonna give him a nitroglycerine tablet. The problem with nitroglycerine tablets often times is that patients will take a bottle of tablets, which you notice is a dark brown colored bottle. And they'll hold it in their pocket. The warmth of holding tablets in your pocket will cause the tablets to disintegrate prior to their age when they expire. One way to determine whether the nitro that a patient gives you, of their own, is effective or not, is to ask them if they have taken any of the tablets, if the tablets taste bitter or sweet. Sweet tablets have lost their potency. Bitter tablets actually are still effective. The other way to determine whether nitro is still effective or not is whether it gives the patient a slight headache after they've taken it. A nitroglycerin tablet like this requires saliva to dissolve. And you wanna be careful when you're taking a nitroglycerin tablet out of the bottle that you have some gloves on, so that you're not absorbing the nitroglycerin medication through your hands. So we'll take a tablet out of the bottle by putting one of the tablets into the cap. And then what we're gonna do is take an ordinary drinking straw and use the drinking straw as a mechanism of delivering the nitroglycerin to the patient. So we'll take the tablet [BLANK_AUDIO] put the drinking straw into the patient's mouth, underneath his tongue. And drop the tablet into the straw. And that gives the medication to the patient. Okay. Nitroglycerin tablet dissolves in about two to three minutes. And what you would like to do is look for the effects of the nitroglycerin five minutes after you've given the tablet to the patient. So a number of things should happen. If you've given it for chest pain, there should be some relief of chest pain. If you've given it to lower blood pressure, regardless, of whether you've given it for that purpose or not, you'd take a blood pressure, and you'd expect to see some change in the blood pressure. Nitroglycerin. Lower his blood pressure in virtually any patient we give it to, so one of the contraindications for nitroglycerin is if a person has a low blood pressure to begin with. And the threshold tends to be a blood pressure of 100-120 systolic below which you would not want to give further doses of nitroglycerin. You can repeat that medicine, spray or tablets, every five minutes and most of the time by the time three doses have been given over the course of 15 minutes time, that's a maximum amount of nitroglycerin and no further effects would be seen from further administration of the nitroglycerin. If the patient's blood pressure drops profoundly, or if perhaps, you've inhaled some nitro glycerine yourself. The treatment for that, is to, lay the person down, until their blood pressure recovers, which will happen when the medication wears off, in about five minutes. The other concern about nitro glycerine. His use phosphodiastorase inhibitors, or drugs that patients may take for erectile dysfunction. And so those are drugs, for example, like Viagra. You'd wanna ask a patient if they used any of those medications within the previous four hours for Viagra, 24 hours for Cialis. And be cautious about giving nitroglycerin to patients who have taken any of those medications in a previous period of time. The reason for that is because those drugs are also blood pressure lowering drugs, where nitroglycerin may exacerbate the effect of the blood pressure lowering. Interestingly despite the warnings about erectile dysfunction drugs or phosphodiesterase inhibitors, there have never been reported deaths of patients who have taken those medications along with nitro glycerine. There have been some reports of extreme lowering of blood pressure, and in those situations you're definitely gonna end up in a. Putting the patient down, doing things to raise their blood pressure back up. For example, raising their legs, if that was to occur. It's best to ask prior to giving nitroglycerin, so you don't put yourself in that situation. Thank you for watching Training Minutes, I'm Mike McEvoy, the EMS editor for Fire Engineering. [BLANK_AUDIO]

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