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mediccjh

Right-side heart failure.

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I wouldn't give Nitro because pt had no chest pain. This pt only complained of SOB. But Nitro is contraindicated in Right AMI. Im not sure about Right CHF. I guess it would be the same principle. I think it has something to do with completely dropping pre-load but im not sure of the etiology but it bottoms out the B/P. This pt needed Lasix more then any other drug.

EDIT: This is based on my states protocols. I know some recommend to consider Nitro in CHF.

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Actually, NTG is on the national standard of treatment for CHF. Of course, eliminating or use in cation with Right sided infarcts...

Be safe,

R/R 911

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Something I wonder is that . was the pts respirations wet or wheezy prior to the puffer/ inhalaton? Alot of peeps think,, well my breathing is bad I need a my puffer or inhalations. I have seen when treating COPD wheezes you can cause what I call a Flash. This is when they go from a tight set of lungs to a flood very fast. I titrate nitro to BP. If their BP will sustain nitro then they get it, but only with a secured iv. When pts get to the weak stage and they begin to lose their effort. Its better to assist them with a bvm and your ET tube at the ready. They usually shut down and then with a little spray and some valium you tube them . They become more comfortable when you take over for them. It causes less stress on the heart. Not to mention you can push the edema across. I am aggressive when it comes to airway/breathing. Its easier to take control then to wait for them to crash, with no BP, no IV and your thumb in your butt.

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You can use CPAP for SOB on COPD pt's too. CPAP would be highly recommended. Rule of thumb is that is your interventions aren't working, then go for the CPAP.

Actually, BiPAP would be the preferred treatment of choice over CPAP. You need to be able to control and adjust inspiratory pressures to prevent autopeeping.

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Of course the pressure would be adjusted and suction if required. I was just stating the short and sweet of it. limited resources too.

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Actually, NTG is on the national standard of treatment for CHF. Of course, eliminating or use in cation with Right sided infarcts...

Be safe,

R/R 911

I agree it is the standard here to give nitro for CHF, Providing that bp is above 100hhmg, An I would have given the nitro and laxis as well.

And that my 2 cent worth on this.

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