Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Caring for Cardiac Emergencies 13

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SCAN 13.1 NITROGLYCERIN

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Medication Form – Tablet

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Medication Form – Sublingual Spray

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Medication Name 1.Generic: nitroglycerin 2.Trade: Nitrostat, NitroTab, Nitrolingual Indications All of the following conditions must be met: 1.Patient complains of chest pain. 2.Patient has a history of cardiac problems. 3.Patient's physician has prescribed nitroglycerin. 4.Systolic blood pressure is greater than 100 systolic. (Local protocols may vary.) 5.Medical direction authorizes administration of the medication.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Contraindications 1.Patient has a systolic blood pressure below 100 mmHg. (Local protocols may vary.) 2.Patient has a head injury. 3.Patient has already taken the maximum prescribed dose. Medication Form Tablet or sublingual spray Dosage One dose is equal to 0.4 mg. Repeat it in three to five minutes. If no relief, systolic blood pressure remains above 100 (local protocols may vary), and if authorized by medical direction, up to a maximum of three doses. Spray is typically prescribed for one metered spray followed by a second in 15 minutes.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Steps for Assisting the Patient 1.Perform a focused assessment for the cardiac patient. 2.Take blood pressure. (Systolic pressure must be above 100. Local protocols may vary.) 3.Contact medical direction, if there are no standing orders. 4.Ensure right medication, right patient, right dose, right route, and right time. Check the expiration date. 5.Ensure that the patient is alert. 6.Question the patient on the last dose taken and any effects. 7.Ask the patient to lift his tongue and place a tablet or spray dose on or under tongue. If you are assisting, be sure you are wearing gloves. 8.Have the patient keep his mouth closed with the tablet under his tongue (without swallowing) until dissolved and absorbed.

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Steps for Assisting the Patient (continued) 9.Recheck blood pressure within two minutes. 10.Record administration, route, and time. 11.Perform a reassessment. Actions Dilates blood vessels. Decreases workload of heart. Side Effects Hypotension (lowers blood pressure) Headache Pulse rate changes Dizziness, lightheadedness

Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O'Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Scan 13.1 Nitroglycerin Reassessment Strategies Monitor blood pressure. Ask patient about affect on pain relief. Seek medical direction before re-administering. Document changes in the patient's condition. Provide oxygen as appropriate.

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