Viagra/Nitro Situation?

[Dustdevil]

This is an ALS discussion.

Medication is Advanced Life Support, regardless of the certification level of the person administering it. This is not non-invasive first aid. And EMT's/PCP's need to very clearly understand that they are practising ALS and not take the responsibility so cavalierly.

EMT (PCP) and BLS are not synonymous. :roll:

[jedifire11]

In MD, nitro tabs/sub-lingual spray are listed as BLS pharmocology and as EMT-B's we assist the pt in administering the med. ALS has there own protocol regarding nitro. Would that be a difference, assisting and actually giving? And for us here, if you've had Viagra/Cialis/Levitra in the past 48 hours, we cant assist in adminstering nitro.

[Dustdevil]

BLS pharmacology is an oxymoron.

But yes, the distinction between "assisting" and "administering" is an important one. One that most EMT's seem to forget.

Regardless, if you are participating in the administration of dangerous drugs, you are practising ALS. Period. I don't care if you're an EMT, a PCP, an EMR or a MFR. Drug administration is not BLS. And it is not merely semantics. It is a very important concept for basics to understand. If you run around thinking, "Oh, this is just BLS because the let EMT's do it," you're going to screw it up and kill somebody. It's serious business. Respect it as such.

[hfdff422]

This is very much a BLS topic- Knowing the contra-indications of medications that are considered within our scope of practice is critical. There are some areas that are considering even allowing BLS providers to carry Epi-pens and nitro spray. If we can administer it, we need to know what the potential harmful interactions are.

This is a fairly new development in comparison to some B's cert date. We have a few old timers that were unaware of the dangers, and one was on a run with me and was ready to give nitro prior to taking blood pressure or asking about other medications. Remember that there are many men who purchase their meds online and are likely unaware that there may be deadly interactions. They see viagra, punch in the old credit card number, and don't read the warnings.

[medik8]

BLS pharmacology is an oxymoron.

But yes, the distinction between "assisting" and "administering" is an important one. One that most EMT's seem to forget.

Regardless, if you are participating in the administration of dangerous drugs, you are practising ALS. Period. I don't care if you're an EMT, a PCP, an EMR or a MFR. Drug administration is not BLS. And it is not merely semantics. It is a very important concept for basics to understand. If you run around thinking, "Oh, this is just BLS because the let EMT's do it," you're going to screw it up and kill somebody. It's serious business. Respect it as such.

Well said Dust...I completely agree...just because it CAN be administered by an EMT doesn't make it BLS drug or situation.

:error:

8

[Dustdevil]

This is very much a BLS topic- Knowing the contra-indications of medications that are considered within our scope of practice is critical.

No! It is NOT a BLS topic! It may well be an EMT topic, but it is NOT a BLS topic. If your MD lets EMT's perform brain surgery, then that becomes an EMT skill, but it does NOT become a BLS skill. There is a difference here that is more than mere semantics, and you need to understand that difference if you are going to practise responsibly and professionally.

BLS does not define a scope of practise. BLS is a very specific group of basic skills. The key term there is BASIC. Anything that is advanced is not basic. Anything invasive is advanced, not basic. And "Basic" is a term we are using to describe the skills being used, not the certification level of the provider. The inability to separate the two in your mind is frightening.

[Ridryder 911]

Again, there are so many that do not recognize their own responsibilities. While there have been so many post of BLS before ALS, so many does not recognize the full extent of providing good and full basic level care. Recognizing side effects of common drugs is a responsibility of the basic EMT. Such as patent's that has a hx. of fall and they have a history of medication of Coumadin, Digoxin, Lisonopril. Certain clue signs and recognition should alert the basic of potential injuries and the patient history by the medication alone.

Part of the responsiblity of administering any treatment to someone is to know the outcome ... good or bad. (intended or adverse effect). This being applying an Ace wrap to using the AED to assisting in use of NTG or even ASA. All have potential adverse side effects, and harm. Knowing these and how to manage them is part of responsibilities of having the qualification of being to administer and use them on patients.

Be safe,

R/R 911

[Dsmittty911]

I will say that I agree with Dust. Meds are an ALS topic but in this case this post should be here because even if not administering the drug EMT-B's should still know contraindications of drugs (ntg, epi pen, etc.) I have actually stopped a Doc from giving ntg to a pt in ER because Doc failed to ask about Viagra. Pt had taken Viagra just 5-6 hours prior to being transported. I also agree about the difference between administering and assisting in administering drugs.

Remember that there are many men who purchase their meds on line and are likely unaware that there may be deadly interactions. They just know they took their Viagra, had a good time, now their chest hurts and that's what they take NTG for. Just for discussion let's say this individual was at grocery store a few hours later, has chest pains, someone that knows you're a Basic gets you to help. Pt says I have NTG for chest pain in my pocket. If basic doesn't ask for sample hx (chest started hurting when good time was over but he figured it would go away. Now it's gotten worse. went from 2 to a 6 on pain scale) The basic lets him take NTG then finds out about Viagra. Too bad so sad. Nothing can be done now. If it were discovered sooner ALS truck can be enroute but pt would still be alive (or at least treatable) Not DRT.

[bandaidpatrol]

No! It is NOT a BLS topic! It may well be an EMT topic, but it is NOT a BLS topic. If your MD lets EMT's perform brain surgery, then that becomes an EMT skill, but it does NOT become a BLS skill. There is a difference here that is more than mere semantics, and you need to understand that difference if you are going to practise responsibly and professionally.

BLS does not define a scope of practise. BLS is a very specific group of basic skills. The key term there is BASIC. Anything that is advanced is not basic. Anything invasive is advanced, not basic. And "Basic" is a term we are using to describe the skills being used, not the certification level of the provider. The inability to separate the two in your mind is frightening.

Down boy! Down!

[AnthonyM83]

There should be no debate at all about this. It is widely known that use of viagra within at least 24 hours is a contraindication for giving NTG. Both drugs act in synergy to produce vasodilatory effects that neither could produce alone. When you throw into the fix a heart that is already being deprived of blood (ischemic chest pain) then you are getting into trouble.

Agreed. Frightening this question was even asked? Not necassarily a slam on the person, but on the school/text book.