Nitroglycerin – SBP drop by one third. Is this a 1/3 drop directly after a dose of nitroglycerin or a cumulative drop after multiple doses/sprays? My understanding was that this 1/3 drop in SBP was being used to determine the pts sensitivity to nitroglycerin. If the pt had mild/moderate SBP drops after each dose it indicated that the pt tolerated nitro well and it was safe to give higher amounts and more doses. However, a large 1/3 drop immediately after a dose of nitro meant that the pt had a high sensitivity to nitro and further tx should be discontinued for pt safety and impending hypotension. Scenario: Ischemic chest pain (Non-STEMI) with an initial SBP of 180mmHg. 1/3 dictates a drop of 60mmHg. After 4 sprays of nitro (with mild SBP drops between each dose) the pts SBP is now 115mmHg. Is this pt exempt from further nitroglycerin because cumulatively their SBP dropped by more than 1/3 OR can I continue to treat because a large 1/3 drop was not seen following an isolated spray of nitro.

I was just curious about a possible contradiction in the Trauma TOR VSA Conditions/Contraindications. In the updated Trauma TOR Conditions it lists that a condtion as “Signs of life when fully extricated with the closest ED >30 min transport time away”. However in the following contraindications it lists “Signs of life at any time since fully extricated medical contact” as contraindicated for the TOR. My question is, in a scenario of a Trauma TOR eligble patient that has signs of life after full extrication, then becomes VSA, would the Trauma TOR apply or not? Would distance to the hospital come into play?