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.