I don't know if you had a resident working or what. But anyway, I suspect that they used NTG to unload him because in Cardiogenic Shock,your SVR is high, and to use Nipride would only send your b.p. lower. NTG would not have as much of a potent affect anyway, but it would still decrease your b.p. Also, it was probably used to open the coronaries as much as possible, and preserve the rest of the heart's functioning. I would have at least put the patient on some dopa after the NTG, esp. since it sounds as if the patient was going into CHF
I've had to call the heart surgeon in to watch a b.p. in the 60's/70's on nipride because my SVR was 2800 on a patient who had an aortic arch replacement. I will never forget this patient, because she was a Circ. arrest patient, and we(or at least I) were very worried about cerebral perfusion. But sometimes I guess you have to live with a low b.p. to correct other things. This patient was already on dopa and surgeon adjusted this and added dobut. after we got the SVR down. His rationale was no use in adding more drips until we get the SVR down. Well, my rationaled was start dobut to get your b.p. up because dobut also decreases your SVR.
You would think they could put a SG with IABP, but maybe there wasn't time or whatever the case. anyway, IABP was first priority I suspect, and since the patient was in cardiogenic shock, it was probably obvious what the pressures were. Not only that, if the patient was on the way to the cath lab, they measure the pressures in the cath lab anyway, and then can put a swan in there.
Thanks for chatting. I enjoy working these questions out.