Question: I am a current PCP taking ACP. I was recently informed, during an ACP class, that on an unconscious CHF patient, nitro can still be administered if vitals are within normal range and the other conditions are met. When I checked the protocols, under conditions, it states that LOA: N/A (whereas for cardiac ischemia, the LOA must be unaltered). However, it seems to me that if the patient is unconscious, the patient is too unstable to receive nitro. I have never experienced a call like this, and it would seem that in most cases an unconscious patient would have vitals outside the perimeters of nitro administration. Can you please verify this? Thanks

 Thanks for the question. We entirely agree with your thoughts on this. We are quite confident that the intention of this directive is not to open an unconscious patient's airway who is suffering from acute pulmonary edema with a jaw thrust so that doses of nitroglycerin (NTG) can be administered. However, there are patients who may have a GCS of less than 15 who could still safely have NTG administered (GCS 14 with eyes open to voice or GSC 13 eyes open to voice but confused for instance). These are judgment calls that the paramedic must use critical thinking to decide if NTG can be safely administered.

That being said, given how effective CPAP is for pulmonary edema, this may be the better option for a patient with pulmonary edema and respiratory distress if available in your service, and provided the patient meets the criteria for CPAP and is not unconscious.

Acute Cardiogenic Pulmonary Edema,Cardiac/Circulation

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