What do you do for chest pain when someone is having CP and their BP is low and may not be able to tolerate the nitro? I had a situation the other day and the cardiologist said give the nitro anyway. The BP was 90s/50s. I know it's not super low and some of them like to medicate these patients until they're symptomatic. I was worried about this patient because when he came in he had a troponin of 94 and they did an emergency angiogram on him. He was in the ICU for a few days and then was transferred to tele. His troponin was coming down but still quite elevated. At the start of my shift he was having CP similar to when he was admitted. Then as my shift progressed the CP became different.
My inexperienced gut was telling me this guy probably needed open heart surgery but the surgeon wanted to wait a couple of weeks. My personal thought was that this guy could drop dead before his CABG. I tried all day to get a hold of the surgeon but he's not the best at returning calls. He finally came around later in the day. I updated him on the patients status and he changed his mind and decided to do surgery on him the next day.
But still I felt like I was in a quandry and didn't really know what to do for this CP because of his low BP.
Nov 9, '07
I'm not sure if you mean SL or a Nitro gtt. With a pressure in the 90s, and chest
pain, I would try the Nitro, especially knowing he's got severe disease. It's really
necessary to dialate those arteries, and the nitro can do just that. If the pain continues and the BP gets lower, there's always Dopamine and a trip back to ICU. Just stay with him and watch him close (as I'm sure you were). It's always good to wait and do bypass after they cool down from a big MI, whenever possible. Their chance of a good outcome is better, hopefully less complications. Sometimes they just can't wait as was the case with your patient. You did a good job!! Sometimes you just have to hound those docs!! Hope your patient did well.
Dec 28, '07
I will typically give Morphine and call the doctor if that isn't helping.
Jan 5, '08
If your unit is like mine, we have parameters to follow. We check B/P and HR prior to giving SL nitro, and if it's OK we start the nitro. If B/P or HR too low, we call the doc. If you cannot get the doc on the phone, get your clin II involved, and tell them whats happening. If I feel uncomfortable giving a med, I will let the clin II make the call and give the med. Even in my short time as a nurse, I have seen too many pts get sl nitro and bottom out. I will always advocate for calling our hospitals MRT, and get the pt transferred to ICU or PCU where they are more familiar with the meds and the problems of a pt with chest pain and low B/P, and can monitor more closely than our unit can.
Never be afraid to speak up and say no to something you feel uncomfortable with...After all, your priority is your pt and your liscense!
Feb 1, '08
What are the O2 sats? Oxygenate accordingly. I would give SL NTG X 1, call the medical director and let him know what is going on. Every second more heart muscle is dying. Then he would probably order MSO4 4mg IVP, an Integrillin drip, and depending upon the BP posssibly start a Dopamine drip. This must be treated aggressively, your pt's life depends upon you.
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