Nitro for CHF

[MeryMellen]

I had a Resident order Nitro x3 SL for CHF the other day, it's something I'd never seen and some of the other more experienced RN's have never seen either. How effective is Nitro in treating CHF? Is this an old tx that a new resident happened to dig up or is it a newer tx? Or is it commonly used and just something that myself and other co-RN's did not happen to know of? Just curious:) Thanks in advance

[EricJRN, MSN, RN]

It's pretty standard down here in TX, even in the prehospital setting. The vasodilation will allow for slightly better cardiac output and will decrease pulmonary congestion. I understand that it's contraindicated in cardiogenic shock though.

[NRSKarenRN, BSN, RN]

the vasodilation will allow for slightly better cardiac output and will decrease pulmonary congestion

:yeahthat:

decrease in pulmonary congestion both atrial and venous helps with diuretic then kicking in. especially used in chf and pulmonary edema; african americans respond better with this treeatment. some chf pts treated with nitro drip in unit.....old treatment since late 70's making a comeback.

emedicine - congestive heart failure and pulmonary edema : article ...

[neneRN, BSN, RN]

We commonly use NTG gtts as treatment for severe CHF in ER, and paramedics frequently start this before the pt gets to us (along with Lasix, of course)...don't know that I've seen NTG SL used for this though, maybe one NTG SL until we get the gtt up.

[danh3190]

I'm looking at the ACLS algorithms and it has NGT SL; Furosemide; Morphine; and of course O2 as the 1st line meds for acute pulmonary edema. These aren't the new recently developed algorithms so can't say for sure if they changed in the last year.

Our prehospital protocols for dyspnea/pulmonary edema call for O2 and 0.8 mg NTG SL if the systolic BP > 140 and 0.4 mg NTG SL if the BP is 101 - 140. We have to get specific MD orders for Lasix and Morphine and also if the BP is 100 or less for dobutamine or dopamine orders.

[Sugah Britches]

Yep, nitro makes everything floppy, slowing down the preload and allowing for a more effective cardiac output.. gets ole Starling back in the curve.

[SpEdtacular, MSN, RN, EMT-P]

I'm a paramedic and when we have someone in CHF we usually do SL Nitro until we can get a Tridil drip going. SL Nitro is nice because it's like bolusing an IV med before you start the drip. It lasts a while so you have a chance to get things going.