Question: A nitro virgin patient presenting with chest pain attends a doctor's office. Doctor administers 1 spray of nitro prior to EMS arrival. Upon assessment by EMS, patient still presents with chest pain. Is the patient still considered a virgin nitro patient as this is the first incident he/she has had with nitro? Or since the doctor administered a spray, does that count as a previous use of nitro?

The SWORBHP teaching philosophy regarding NTG and ischemic chest pain has always been previous prescribed use. Meaning, the patient at one point had been advised by a health care professional to take NTG for this suspected ischemic discomfort, and the patient had in fact done so without complication.

In the scenario you describe above, you have a patient who has had NTG administered by a physician for chest pain of a presumed ischemic etiology and this was done without complication. As such, the SWORBHP Medical Council would consider this as previous prescribed use and as such would be supportive of the paramedic administering subsequent dosages of NTG as per the medical directive.

Acute Cardiogenic Pulmonary Edema,Cardiac Ischemia,Cardiac/Circulation

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