Is nitro spray contraindicated when someone is short of breath without chest pain?
:thnkg:
pt. just had diagnosis of CHF and just came back from hospital at beginning of month once pneumonia was cleared.
vitals - BP - 143/86 P - 80 O2 sats- 80% on 100% non rebreathe 28 resps/min - indrawing abdominals and at the neck - diaphorectic - pale
pt. denied having chest/jaw/L arm pain
I administered one spray of nitro sublingually - thinking that it would help with his SOB... once EMT arrived they said - shouldn't have done that. I need to learn ...please give feedback.
We given nitro all the time for CHF, along with Lasix, O2 and usually a little morphine ( 2-4 mg IVP). The doc will order up to 3 SL q 5min while we are setting up the gtt, then titrating the gtt to BP. Once the pt is stable they may be switched to topical.
It does several things: dilates veins and reduces preload(less fluid coming into the right side of the heart and thus to lungs; dilates the coronary arteries increasing blood flow to myocardium; and reduces systemic vascular resistance so the left ventricle can fill and squeeze.:heartbeat
The main contraindication would be a low bp, say less than 90 systolic, so you would monitor the BP with each dose of nitro.
If BP starts to go low, we titate drip q5minutes down 5 mcgs....if that mean to off....then we go off. Also, if patient starts becoming symptomatic we will titrate down.
As far as thinking the NTG would help the SOB....How does NTG act in the body?
Exactly dude, how does NTG act in the body? Nitroglycerin works by generating nitric oxide which stimulates the production of cGMP. This causes peripheral vasodilation, decreases preload and relieves pulmonary edema. Basically, nitroglycerin unloads the heart resulting in decreased myocardial oxygen demand, increased coronary perfusion and slightly decreased afterload. Seems like a good choice for someone with congestive heart failure.
One dose of SL nitro spray delivers approx 150-300mcgs of nitroglycerin. Is that enough to make a difference in this situation? Who knows. If I was in this scenario a better delivery of oxygen, morphine and some sort of loop diuretic would be nice too, depending on the confirmation of further objective findings. Maybe even some natrecor in the hospital setting. To the OP...don't listen to everthing an EMT tells you.
I don't think nitro is going to increase hemoglobin, but it may very well increase the amount of blood getting through, which will increase 02 saturations or should.
Specializes in Management, Emergency, Psych, Med Surg.
I would have absolutely given the patient nitro. Due to the vasodilitation effects, it reduces pre-load and thus results in reduced work load on the heart. In an emergency situation such as you described, giving high flow oxygen and nitro was the correct thing to do.
MAISY, RN-ER, BSN, RN
1,082 Posts
If BP starts to go low, we titate drip q5minutes down 5 mcgs....if that mean to off....then we go off. Also, if patient starts becoming symptomatic we will titrate down.
Maisy