Nitro drip

[ptsfirst]

When would you expect to see a Nitro drip started? I am working in a PCU where pts are experiencing active chest pain with increasing troponin levels and we aren’t starting drip (I know that they usually don’t do nitro in PCU)... we aren’t transferring to ICU either.... just want to understand why no drip...

[MunoRN, RN]

The big reason would usually be an active infarct affecting the right ventricle, in which case nitroglycerin is contraindicated.

But in non-RV infarcts you have a valid point, if there is good reason to suspect that the patient is actively infracting, then typically the goal should be to become chest-pain-free with a nitro drip being a common tx and often a heparin gtt as well until further diagnostics / intervention can occur.

It varies by facility, but the PCUs where I've worked do nitro and heparin gtts, since most often the nitro drip requires little to no titrating after the first hour or so, but they are hemodynamically labile on the drip then they may require a higher level of care.