Nitro for HTN>?

[locomedic21]

Does anyone do it? , It is not in our protocol to do, but i was with a more experienced medic and we had a lady with 280/190 b.p. got a line, he gave some to lower b.p. well it worked but i was taught not to do it. was wondering what all your opinions are on it?

[DaSharkie]

I used to think it was OK, but after further schooling and reading I will say not to.

The protocol for reducing hypertensive crisis, is nitroglycerin infusion under close seupervision and monitoring. One single SL NTG is not going to do anything for the long term management of the patient.

Besides, what is the reason for the hypertension? Tumor? Lesion? Brain stem herniation? Disorder of the pituitary gland? Overproduction of angiotensin?

Why is this occuring and what is the most proper method for treating it? It is not going to be corrected in the back of a bus. Especially if there is evidence of end organ damage; to include parasthesia, paralysis, or altered mentation.

I am not saying that this applies in your particular case, but as a rule.

[BFD Medic424]

Our protocols say we can give SL NTG when systolic pressure is above 220. I've done it a couple times. It seemed to work in bringing the pressure down both times. Once we arrived to the hospital they didn't give any more SL.

[btroutm]

In my old system we had protocols for nitro paste in symptomatic hypertensive patients. Neither of my current systems have standing orders beyond routine medical care. Upon medical control direction, we can give SL NTG.

From my experience, SL NTG will usually bring the BP down. It is, however, only a temporary solution. Without treating the cause of the hypertension, the BP rises after the effects of the NTG have worn off. Like anything, using NTG for hypertension has its pros and cons.

[RyanEMVFD]

We give 3 shots of nitro 5 minutes apart and if that doesn't work give labetalol.

[IAMedic]

Funny, we just talked about this at our training tonight with our Medical Director. He recommends SL Nitro x 1 q 5 minutes up to three doses and four if they remain stable....He says that's the best thing for them and cocaine addicts that are complaining of chest pain...go figure...along with the other things of course....

[DaSharkie]

He says that's the best thing for them and cocaine addicts that are complaining of chest pain

The effects of NTG with the cocaine use is due to the high prevolence of coronary vasospasm with the cokeheads.

[CoolDre]

We get 1 spray after 10 min we can call in for another

we also have labetalol, but there are a LOT of qualifications, bp over 200/130, >18 <45, no cx pain, no s/s of CVA, etc...

[locomedic21]

i asked a couple ER docs they said not to use NTG for HTN because they do not want the pressure to come down too fast because of pressures in the vessels in brain, with the sensativity and all, i guess med control will determine if i use it or not in my next hypertensive crisis. thanks all.

[volparamedic]

We no long us nitro for a HTN crisis. They claim that it is an uncontrollable way of lowering a blood pressure. Depending on what's going on depends on what to do. If someone is having a stroke and is hypertensive due to the need for increased oxygen...why would you want to lower the blood pressure uncontrolled/drastic? Nitro does the opposite for the brain as it does for the heart. Save the punumbra!!!!

[Nate]

We give 3 shots of nitro 5 minutes apart and if that doesn't work give labetalol.

Can't wait until we have labetalol!:respect:

[Garyb3985]

Our protocols say we can give it and I do.Quite often actually,but I always have a IV before the nitro.I have a supervisor that has always said our job is not to treat the Pt,but to get them to the hospital in the same or better condition than I found them, where they can get the difinative care that they need.And I agree with that to a point.

I said that to say this.Does me giving the Pt a nitro to lower BP going to fix the under lying problem,No.Will they get there in better shape than I found them,if they have a BP of 220/120,yes I believe I got them there in better condition......IMO,but I have been wrong before.(just don't tell anyone!)

[brandman]

Most pt. with hypertension are non compliant with their medications, so lowering the BP with SL Nitro is only temporary, but so is most of out interventions in the field anyway! SL Nitro is the less invasive Tx, but as always, make sure the pt. is not presenting with signs of a CVA! IV Labetalol works the best, and if you are nervous about giving 20 mg IVP in the field, consider that the M.D's can give up to 300mg at the ED!!

:o

[Epinephrine]

Along with what others have said... it is an uncontrolled dropping of the BP. I'm sure our PA student can correct me if I'm wrong here... A rapid dropping of the patients blood pressure can also trigger an overcompensation by the body thereby raising the BP again to usually levels higher than with out the Nitro. In a +CP pt the Nitro is given as a vasodilator to increase blood flow to cardiac tissue, thereby increasing O2 to said tissue. The decrease in BP is a side effect, not a method of action.

I know my instructor during medic school beat into us that given Nitro to reduce BP was a very bad thing.

[smurfe]

We no long us nitro for a HTN crisis. They claim that it is an uncontrollable way of lowering a blood pressure. Depending on what's going on depends on what to do. If someone is having a stroke and is hypertensive due to the need for increased oxygen...why would you want to lower the blood pressure uncontrolled/drastic? Nitro does the opposite for the brain as it does for the heart. Save the punumbra!!!!

I see someone there took the same Stroke Class I did. Actually, prior to taking that class, I never gave NTG for hypertension. After taking this class I became pretty good at identifying the signs and symptoms of stroke (wasn't bad before for years, but now just better). What this class really enabled me to do was to distinguish a bleed from a clot a whole lot better which influenced my treatments as well.

In regards to NTG, I would normally only ask to give NTG paste if any. I usually asked for Labetolol and only if I had a bit of time to the ER. Karen is correct that if there is a clot or some O2 deprived area of the brain, the BP is elevated to force blood to the deprived area such as around a clot. Good thread here.

Smurfe :beer:

[brandman]

People, naturally a neuro assessment has to be done BEFORE lowering of any BP. There are many medics out there that are missing the signs and symptoms of a CVA. This is probaby why your medical director has removed Nitro and Labetalol from your protocol. Also, a 12-Lead must be done to rule out an infarct.

:D

[smurfe]

People, naturally a neuro assessment has to be done BEFORE lowering of any BP. There are many medics out there that are missing the signs and symptoms of a CVA. This is probaby why your medical director has removed Nitro and Labetalol from your protocol. Also, a 12-Lead must be done to rule out an infarct.

:D

I have never had a protocol at anyplace I worked in 25 years that allowed me to do this on a standing order, nor would I want it. If anyone standing orders allow this RX would really think twice before throwing the NTG to them. I for one have always felt that this was something better left for the controlled environment of an ED plus I never seen a patient I thought was gonna die right now without lowering their BP immediately.

Smurfe :beer:

[DaSharkie]

Along with what others have said... it is an uncontrolled dropping of the BP. I'm sure our PA student can correct me if I'm wrong here... A rapid dropping of the patients blood pressure can also trigger an overcompensation by the body thereby raising the BP again to usually levels higher than with out the Nitro. In a +CP pt the Nitro is given as a vasodilator to increase blood flow to cardiac tissue, thereby increasing O2 to said tissue. The decrease in BP is a side effect, not a method of action.

I know my instructor during medic school beat into us that given Nitro to reduce BP was a very bad thing.

Good points here.

Please do not take anything I type as gospel - just information I pass on from clinical experiences and the education that I have been given. Always research it yourself with a good medical book to help put you to sleep :D .

If the body needs the extra pressure to accomplish its response to an ongoing issue within, then your administration of ntg is not going to help since the body will be refractive to it in the long run - by raising its BP as soon as possible.

Folks we need to remember that definitive care is not going to be (nor should it be) accomplished in the back of an ambulance or on a scene. Definitive care is found in the big brick building that has a sign out front saying "HOSPITAL." Don't get me wrong, this can be easy to forget, but we need to remember this.

Off to Trauma Call I go. :jig: :jig: :jig: :jig: :flame: :flame: :flame: :flame:

[smurfe]

Folks we need to remember that definitive care is not going to be (nor should it be) accomplished in the back of an ambulance or on a scene. Definitive care is found in the big brick building that has a sign out front saying "HOSPITAL." Don't get me wrong, this can be easy to forget, but we need to remember this.


Hey now, didn't I just say this?:rolleyes: :respect: :smiley_ab :

I for one have always felt that this was something better left for the controlled environment of an ED plus I never seen a patient I thought was gonna die right now without lowering their BP immediately.

Smurfe :beer:

[Nicoli]

Where I work we don't have dialysis! We have had patients come in to the ED when they are 12-24 hours out from having their dialysis. When they come in they are very hypertensive and they are having severe difficulty with breathing and their lungs are very wet. The local nephrologists reccomends that when we get patients in like this that we treat them with the following:
CPAP, 200-300mg of lasix, and either a nitro drip or nitro paste for the hypertension. These patient get almost instantaneous relief and within 20 minutes they are off the CPAP. The neprologists likes the nitro because it is quick on and off. Blood pressure is temporarly controlled until they can get to dialysis. But this is the only scenario I can think of when I have used nitro to control / treat hypertension.