Cross-posted with Cardiac Nursing:
95 y.o. female with an ORIF of her hip yesterday (I know, I know ... but that's another thread...) who developed chest pain on the floor, with hypotension. Highest Troponin I so far = 124.8 and still rising. Major ECG changes. Echo shows an EF of 35% with ventricular wall motion abnormalities and dilated cardiomyopathy. Dopamine ordered at 2 mcg/kg/min to maintain SBP 90-120 (currently in low-100s). Also has a NTG patch on.
I asked the internist on the case (no cardiologist) if I could take of the patch and she said "No! It's taking the place of the nitro drip!"
This seems crazy to me. I'm on a temporary assignment (only 4 shifts left, thank God!) from my staff position in a CVICU. Granted, I've not been in critical care for that long (three years), but it seems to me that we should not be using NTG. Especially in light of her EF and cardiomyopathy, I would think that continuing venous dilation isn't the best choice. Also, why have the dopamine fight the NTG? Even when working with open-heart patients immediately post-op the use of a NTG drip to prevent vasospasm is contraindicated by hypotension.
As I said, I realize that I'm not an old pro yet. So I'm asking some old pros: Is NTG the best choice in this situation?