top of page

Nitro spray (NTG)

Indications: Pt with chest pain who has prescribed NTG and who is awake and alert

Contraindications (Do No Give): Systolic BP below 90 mm HG, Pt has already taken 3 doses of NTG for this chest pain episode, Pt is taken Viagra, Cialis, or Levitra or similar drugs within the past 24 hrs.


Procedure: Ensure ALS unit is en route

  • Complete full assessment (Med hx., meds, allergies)

  • Apply O2, if pt. having chest pain or discomfort

  • Ask if pt has taken any of personal prescribed NTG, including how much and when (documented)

  • If no relief from O2 and/or NTG already taken, if no contraindications, consider assisting with single dose of NTG

  • Update V/S every 5 minutes (document) - if pt. becomes hypotensive, elevate legs as tolerated. Give detailed report to resounding ALS unit



- Tap packet to ensure medication is all together.

- Tear packet at tear line.

- Pour entire packet under the patient’s tongue.

NTG TABS: Place one tablet of NTG under tongue and advise pt. not to swallow it

NTG SPRAY: Do not shake bottle prior. Direct spray under tongue or to side of inner mouth. Advise pt. NOT to inhale


Document: Complete assessment and V/S, description of need to assist pt. with NTG, time for NTG, and response to NTG

Meter dosed inhaler (albuterol)

Indications: Respiratory distress in pt with prescribed Albuterol or Imratropium (Atrovent® MDI)

Contraindications (Do Not Give)): Altered mental status, expired prescribed MDI, known allergy to med, crush injury


Procedure: Ensure ALS unit is enroute

  • Perform complete assessment, including V/S (document) – for pt w/ difficulty speaking consider upper airway obstruction

  • Verify respiratory distress (wheezing, accessory muscle use, labored breathing), *Absent wheezing may be due to low air exchange*

  • Provide supplemental 02 appropriate for patient and condition

  • Verify MDI is labeled and not expired

  • Do not shake MDI.  Assist pt. with administration of MDI medication (remove nozzle cover)

  • Have pt exhale and place MDI to lips, have pt seal lips around nozzle and INHALE

  • Fully depress med canister into holder while pt inhales, remove MDI and have pt. hold breath for 10 seconds (or as long as possible)

  • Allow pt. to resume breathing and when able repeat 2nd dose (steps above), resume 02 therapy and update V/S every 5 minutes and document.  Give detailed report to ALS unit


Documentation: Chart complete assessment and V/S, time/s for assisted admin of MDI, name of MDI, description of why pt. needed assistance with inhaler.

bottom of page