How risky is nitro without a line?

[bryan20w]

I also am a advocate for getting an IV prior to giving nitro, however i also can appreciate the need to not delay transport. In the event that an IV can not be gotten due to bad access i am curious as to everyones opinion on going with the Nitro and having the EZ IO readily available just in case? I know that that is by far not the ideal situation but is an option.

[AZCEP]

With the presented scenario, I'd be hesitant to use the IO. I've just not had good experience infusing large amounts of fluid with that route. The medications can be withheld for a bit, but these patients tend to need volume replacement.

[Jwade]

Hey Guys,

I hope you are not stating categorically that MI patients need volume replacement? This would be seriously inaccurate.

As far as NITRO dilating the coronary arteries, this has been proven false over and over again.....What NITRATES do cause are reduction of preload, which occurs due to dilatation of venous capacitance vessels, resulting in a decrease in myocardial oxygen consumption. Nitrates act as an exogenous source of nitric oxide, which causes vascular smooth muscle relaxation and may have a modest effect on platelet aggregation and thrombosis.

Remember, someone having an MI is going to be anxious, in pain, etc.....causing vasoconstriction, the whole goal of giving TX is to reduce MVo2 demand! Do most of you still stick on a NRB at 15lpm on these patients as well? Another Myth that has been passed down through years of old school science and teaching!

I will dig up the studies about the coronaries and dilatation, and post them for your reading and education pleasure!

Respectfully,

JW

[spenac]

I will dig up the studies about the coronaries and dilatation, and post them for your reading and education pleasure!

Respectfully,

JW

As a paramedic student I look forward to seeing those. Thanks.

[towheadedmule]

Its also in the book pathophysiology of Heart Disease.

Its listed in the recommended reading list on this forum.

Really good book, IMHO

As for the thread, I always get a BP and pulse before I give nitro, but not necessarily a 12 lead or a IV lock. Usually the sequence is BP/pulse by fire prior to my arrival, determine need, ASA, 1 Nitro, meanwhile partner is attaching Lifepack while I do the line, 12 lead, time to determine need for second spray, move to cot/truck, MSO4...............rinse lather repeat...

It works well for me. YMMV