Nitroglycerin and IV Access in a STEMI Patient
Hey Dr. J,
Recently I responded to a call with a female in her early forty’s complaining of chest pain. In my 12 lead ECG assessment, STEMI was revealed in multiple leads. I administered sublingual nitroglycerin twice on scene and once en route. The patient’s systolic BP never dropped below 200 systolic. I was not able to start an IV due to poor veins. I was also less than one mile from the hospital. After documenting this call, it was audited. Though mostly positive feedback was given, one of the things i was criticized on was the administration of more than one nitroglycerin prior to having IV access. I was hoping you could give me your opinion if I should have withheld the much needed Nitroglycerin?
Stem E.
Dear Stem E.,
It is ideal to have an IV while administering nitroglycerin in the event that the patient’s blood pressure drops and needs fluids. I would not withhold NTG from this patient because of the absence of an IV. Why? Because nitroglycerin’s benefits outweigh the IV issue. Our protocols DO encourage an IV prior to the second NTG so that medics are reminded about the importance of IV access.
I would, however, be very vigilant about monitoring the blood pressure and would be ready to put in an IO quickly if the pressure drops.
Dr. J
Ross Judice, MD, MPH
Chief Medical Officer
Acadian Ambulance Service, Inc.
Add comment October 25th, 2009
