Question: When is a patient no longer considered nitro naive? Issue: you have a patient that is suffering chest pain and qualifies for ischemic protocol. You establish a patient IV and give them nitro. The patient accepts the nitro without any adverse reactions and pressure does not fall out of protocol at any time. After your second dose of nitro you check the IV and discover its no longer patent and you have to discontinue it. You attempt your second IV and are unsuccessful. Nitro has been decreasing patient's pain but they still have active chest pain. Can we still continue with nitro without an IV as the patient has already been given nitro and not had any reaction?

 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.

The situation you describe above is not in the spirit of that teaching. The correct course of action in the case you describe would be to withhold further NTG administration unless another IV can be established.

Cardiac Ischemia,Cardiac/Circulation

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