This just might be a fluke experience that happened in two days but the drops have been substantial that it kinda makes me wonder if this is commen to drop to these extremes or indeed just a freak two day experience. Heres the low down............
Day one: Fairly healthy older gentlemen came in with substernal CP. NSR, vitals in the 130/90 range. Gave 4 81mg asa and ordered SL nitro 0.4, x3 q.5 min for CP. Hold if systolic
Day two: Covering another pt while nurse goes to lunch. Substernal cp. Sinus tach on the monitor. BP 120/something. Give one SL nitro with not much relief. 5min later cycle pressure. Still around 110/something. 2nd SL nitro. Pt states he is lighteheaded. Lay pt supine, bump up o2, cycle pressure. 74 systolic. DAMNIT! DR. notified, nurse's now laughing at me, pt gets a 500 fluid bolus.
I have worked in the ER for almost two years, pre hospital almost 15 years. I have never had this happen before. I understand it is a vasodilator but geesh. No other medications were being administered other than asa. No obvious infarct going on, no ST changes before or after. Just drastic dropping of the pressures easily reversed by fluid boluses.
So, any other experiences like this? This is why I NEVER given nitro without iv access.
I have this happen to me once or twice a year - some patients are VERY sensitive to nitro. Example: female 58 years old, chest pain, no meds, after IV in, BP 158/90's, first nitro - within a minute, her face is turning ashen, she states she feels very, very dizzy - HOB down, BP cuff cycling and IV open wide. BP is now 70/50's. Recovered after fluid bolus, HOB back up after about 15 minutes and BP in 120's/something and no more nitro. It CAN happen, doesn't happen frequently, that is why I always stay at the bedside for an extended period of time when giving a first nitro to someone who has never had this med before.
Who is obtaining a 15 lead or at least looking at V4R prior to NTG in inferior MI?
it's not always done, looking at V4R, prior to giving NTG for a suspected inferior. As a matter of fact, once the EKG determines STEMI vs NSTEMI, then the orders are given. RARELY do we do V4R.... now watch, tonight it'll be done while I'm at work...
Specializes in Emergency/Trauma/Critical Care Nursing.
i agree with what everyone else has said about people being hypersensitive, possible interactions with home meds etc. however i wonder if it is possible that the ntg bottle was actually 0.6mg dose vs 0.4mg which i personally have never seen in my ER but it does exist and from looking at pictures on the web it does look very similar. and of course you are always supposed to check right dose/med/route etc etc but if its not a dose routinely used where you work and it got mixed in with the NTG SL d/t pharmacy error, it might easily get administered accidentally. the only reason i bring this up is because the situations you described were in such close proximity that it made me wonder...
No, the dosage was 0.4. We only carry 0.3 and 0.4 in our ER. I came to believe it was just a fluke experience that was just coincedance it happended two different days.
Oh, and a side note. To the poster who stated Nitro causes bradycardia, it has no effect on heart rate. It is a vasodilator. The heart rate my decrease as pain and blood pressure decrease but it has no direct effect on rate or rhythm.
gardengal1, ASN, RN
82 Posts
I have this happen to me once or twice a year - some patients are VERY sensitive to nitro. Example: female 58 years old, chest pain, no meds, after IV in, BP 158/90's, first nitro - within a minute, her face is turning ashen, she states she feels very, very dizzy - HOB down, BP cuff cycling and IV open wide. BP is now 70/50's. Recovered after fluid bolus, HOB back up after about 15 minutes and BP in 120's/something and no more nitro. It CAN happen, doesn't happen frequently, that is why I always stay at the bedside for an extended period of time when giving a first nitro to someone who has never had this med before.