In regards to the contraindication for NTG regarding SBP dropping by 1/3 or more, should we basing this off the very first BP obtained on that call, or a BP obtained right before NTG usage? Ie. ischemic chest pain 00:00 BP of 180/100 00:03 SBP of 150/90 00:04 NTG usage 00:09 BP 115/75. In this case a 65 (180-115) point drop would rule us out if 1st BP counted, but a 35 (150-115) point drop would not rule us if BP prior to NTG used. As pts can often be particularly stressed/anxious right when we walk in the door, it would make sense to me that the BP closest to actual administration would be most indicative of their true clinical state.

When we do a 12-lead and have inferior involvement, the directive states that we assume there is right sided ventricular MI and must confirm with V4R, and then states we should never give nitro for right sided ventricular STEMI. All of that is clear, but what I am wondering is that if the V4R is negative, does that clear the pt for Nitroglycerin use for the inferior STEMI, or does that simply help confirm the STEMI for the emergency department? Thanks.

Why do you only give 3 sprays of nitroglycerin to a STEMI positive patient?

If a dentist administers nitroglycerin to a patient who has no previous-prescribed use; does this constitute prescribed use at this point?