Date Published

January 19, 2012

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: Nitro Protocol for CHF the new protocol diagram says... Consider nitroglycerin: ‰¥140 mmHg, IV or Hx 0.6 or 0.8 mg. I have been told the diagram is wrong and I cannot double dose unless I have an IV regardless of history. If this true can you fix the diagram and issue a clear concise overview of this protocol?


 This is a frequently asked question and we have addressed this with the Province for a consistent change. Currently the interpretations of this directive vary both in the SWORBHP region and among other BH programs. The confusion surrounds the indications stating that in order to receive NTG, a patient must have either a history of use OR an IV established. Then, on the second page, the dosing listed on the "treatment" box states that if "no IV or Hx" and the BP is >140, then a single dose of NTG can be administered q5min with up to 6 doses maximum. Some BH programs think the first indications box needs to change, others believe that the second box needs to change meaning if you have no IV or Hx, despite a BP >140 systolic, no NTG should be administered. SWORBP Medical Council does not want to change one way only to change again when the final decision is made by the MAC. Therefore, for now, when the BP is > 140, as per the chart, single doses of NTG are acceptable however the ideal would be to have a prior use or an IV established. Withholding NTG from this subset of patients at this time would also be acceptable until this is clarified at a Provincial level.



Congestive Heart Failure (CHF), Intravenous Therapy (IV), Nitroglycerin (Nitro NTG), Protocols (Protocol) Medical Directives (Medical Directive)

Additional Resources

No additional resources are available for this SWORBHP Tip.