Nitrolingual

[Dustdevil]

So in all actuality this route that Gvandellens mentor was doing is NOT wrong.

I don't think anybody is really saying that on the tongue is wrong, as much as we are saying that his mentor was wrong to be a medic for twenty friggin' years and remain completely ignorant to the fact that he not only could give it sublingually, but that it is the physiologically preferred method. That is scary. Especially when his protocols specify sublingual in writing.

I mean seriously, is that what paramedic education has been reduced to? Is the total sum of our knowledge limited to what is written in patient instruction inserts? We don't need to take Anatomy & Physiology, Pharmacology, and Pathophys anymore because we can just do whatever our mentor says he's always done?

I'm just not ready to accept that the profession has degraded that far.

[akroeze]

If they are that crapped out, would you still want to give nitro?

If they are hypertensive, flooded to the point that their eyeballs are floating and semi-conscious then Nitro is going to be still an option to me. It's one of the few things i can do to help them.

Oxygenation, assisted ventilation and nitrates.

[Asysin2leads]

Yes, nitrates are still an option, yet with someone with hypertensive crisis such as you described, nitropaste would be the preferred method, not spray.

Hoookey dokey. Gvandellen, I'm confused. First you come in stating facts that run contrary to fairly firmly held and proven medical theory, then you attack others credibility when debating you, then state assertions such as "sublingual doesn't necessarily mean under the tongue" which, now also challenges certain definitions from Latin, and then you state "look, I really don't want to turn this into an arguement." My question is, given all that, what did you think was gonna happen? Do you usually go into biker bars, insult Harley Davidsons, and then tell everyone you don't want a fight, too???

The bottom line is sublingual means "UNDER THE TONGUE", and when you document 400 mcg S/L, then it needed to go UNDER THE TONGUE. Otherwise, you need to put, in your documentation, something such as "spray failed to enter sublingual area when administered" and accept the chips where they lie. If you feel comfortable enough standing in front of a medical review board with the drug insert and your instructors advice behind you, go on with your bad self.

On a slightly different subject, I'm glad I'm not the only one who has trouble getting that first spray of NTG out of the bottle. I find "priming it", either pointed towards the garbage, a red bag, or the paramedic student, is a good way to make sure that first spray really gets administered.

[akroeze]

Yes, nitrates are still an option, yet with someone with hypertensive crisis such as you described, nitropaste would be the preferred method, not spray.

If all you have is the spray (as that is all I have) would you reach in there and lift up their tongue or would you simply spray it onto the tongue/into the mouth as some is better than none?

I also find that spraying it straight up creates a nice air freshener effect to the room/truck

[Dustdevil]

I also find that spraying it straight up creates a nice air freshener effect to the room/truck

Several months ago, I was standing outside my office, wasting a bottle of expired Nitrolingual into the air. Some bureaucrat walked by and actually insisted that I stop it immediately until a HazMat officer could come and tell him if this was legal.

[Michael]

Some bureaucrat walked by and actually insisted that I stop it immediately until a HazMat officer could come and tell him if this was legal.

"But Officer!" protested Dust, "Do you want the terrorists to win? It says right here that "The spray can also be used to prevent an anticipated attack!"