Nitro for CHF

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.

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.

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.

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

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.