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.
[MUSIC] Hi, welcome to Training Minutes. Today we're going to talk about administration of nitroglycerin. Nitroglycerin given to patients with chest pain comes in two different forms. We see nitroglycerin spray that patients may carry and we nitroglycerin tablets. So I want to talk first about the spray. You give nitroglycerine 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 nitroglycerine and I wanna show you for a second. What the nitroglycerin spray looks like when it sprays. [SOUND] That mist is all medication. If your face is near the patient when you spray the nitroglycerin underneath their tongue, you have a likelihood of inhaling the nitroglycerin and having the medication take effect on you, yourself. As well as the patient. Not a good idea. The other form of nitroglycerin is nitroglycerin tablets. Now we've taken a patient's oxygen mask off and we're going to give him a nitroglycerin tablet. The problem with nitroglycerin tablets oftentimes is that patients will take the bottle of tablets, which you notice is a dark brown colored bottle. And they'll hold it in their pocket. The warmth of the 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've taken any of the tablets whether 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 actually effective or not is whether it gives a patient a slight headache after they've taken it. The 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. Put the drinking straw into the patient's mouth underneath his tongue. And drop the tablet into the straw. And that give the medication to the patient. Okay, nitroglycerine table dissolves in about two to three minutes and what you would like to do is look for the effects of the nitro glycerine 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. And nitroglycerin. Lowers blood pressure in virtually any patient who you 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 the maximum amount of nitroglycerine, and no further effects will be seen from further administration of the nitroglycerine. If the patient's blood pressure drops profoundly or, if perhaps you've inhaled some nitroglycerin 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 nitroglycerin. Is the use of phosphodiesterase inhibitors or drugs that patients may take for erectile dysfunction. And so those are drugs for example, like Viagra. You would want to ask a patient if they have used any of those medications within the previous four hours for Viagra, 24 hours for Cialis. And be cautious about giving nitroglycerine 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 nitroglycerine may exacerbate the effect of the blood pressure lowering. Interestingly, despite the warnings about Erectile Dysfunction drugs, or [INAUDIBLE] there have never been reported deaths of patients who have taken those medication along with nitro glycerin. There have been some reports of extreme lowering the blood pressure and in those situations you definitely gonna end up in the. Putting the patient down. Doing things to raise their blood 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 McAvoy, the EMS editor for Fire Engineering, [MUSIC] [BLANK_AUDIO]