Crushing nitro on right side STEMI!

[Banana nut]

Hi all, I am a nursing student and I work as a tech. Recently while working in the ER we had a walk in with chest pain. We ended up giving nitro and his bp dumped from 140/80 to 60/35....needles to say that was a shocker for me. We ended up transporting the pt to a hospital with a cath lab and he had 95% blockage of his Right coronary. My question is; has anyone else experienced this phenomena and if so what is they best way to handle it? Thank you

[~Mi Vida Loca~RN, ASN, RN]

That's a good reason why the EKG needs to be read prior to treatment by someone adequately competent at reading ischemic changes and where they are located. Pretty much every ED nurse can recognize a STEMI or obvious arrhythmias, NSTEMI's require a higher level of competency and experience.

I don't disagree. But that's not always the case. Sometimes on a night shift there is one doc there and you find out they aren't as good at recognizing a RVI. Or the doc that picks up the patient misses it, or doesn't believe the nurse when it's pointed out. Many variables can come into play. But yes in an ideal situation you have time to do an EKG and have someone very good at reading them and avoid a situation like this all together.

[~Mi Vida Loca~RN, ASN, RN]

Yeah he came in looking dumpy but ended up not coding. He got to the cath lab and was saved! It was a cool experience, he was in and out in less than 15 minutes.

Always nice when it works out that way. Charge likes it too. By the time I am back to my zone from running to the cath lab there is already a new patient waiting for me in the empty room. lol

[NICU Guy, BSN, RN]

I have never seen a patient come in with the chest pain and dusky color that did not code within a couple minutes of vomiting, in fact when all the media was covering the Robin Thicke story and they said he started vomiting I told my friend, this isn't going to end well.

You mean his dad, Alan Thicke?

[~Mi Vida Loca~RN, ASN, RN]

You mean his dad, Alan Thicke?

Yes I did mean his pops! When I was typing it I was thinking about Robins song and never realized I typed his name instead.