I was an RN for 7 years on an extremely busy med-Surg floor and gave plenty of nitro during emergent situations. I just transferred to the ER and a guy had an MI. So I went to grab the nitro and aspirin and heparin per Dr and my preceptor said what kind of MI? Then he explained this quick and I was sort of in shock. I had no idea it made a difference. Great video. I subscribed. Awesome resource.
The research on this topic suggests we should continue giving nitro regardless. The hypothesis is reasonable but in practice there doesnt seem to be the dangerous drop in preload that this line of reasoning suggests. Of course always follow your protocols.
Exactly. At the very least the drop in blood pressure does not seem to be significantly different when comparing myocardial infarction w/ right ventricle involvement with myocardial infarction w/o right ventricle involvement.
From a physiologic standpoint I can see how it became a recommendation. However, if you have a patient with a myocardial infarction largely affecting the left ventricle and you give nitroglycerin, then you reduce venous return to the right ventricle and reduce right ventricle cardiac output. The preload of the left ventricle is largely dependent on the right ventricle cardiac output so why isn't the same recommendation made for this instance if we're looking at it from a physiologic standpoint?
It's great to be a part of presentation,the total functional output of stroke volume of heart but we are not able to forecast which veinlet will be having obstacle or the maun portion may be Myocardium space will be hindered,the next stroke will also produce depression or such,so on the next phenomenon the output will be chaining.
Well perhaps considering the RV is not very strong and is really dependant on preload for volume whereas the LV has 6 times the muscle as the RV (so I believe)
Thanks for a great video. In my service (where tablet GTN is administered sublingually) inferior STEMI is not a contraindication. Instead it is contraindicated for hypotension or extremes of heart rate, presumably for the similar reasons (decreased preload) as inferior MI is a contraindication in many services as discussed in this video. I was also told by instructors to consider withholding it for posterior MI but again, not a contraindication where I work. What are your thoughts on using BP and HR as the main guide for withholding GTN instead of the 12-lead results? Is it possible/likely for a patient to be having an inferior and/or posterior MI and still have BP and HR between the flags? If so, do you think it would still be risky giving GTN in such a situation?
I was an RN for 7 years on an extremely busy med-Surg floor and gave plenty of nitro during emergent situations. I just transferred to the ER and a guy had an MI. So I went to grab the nitro and aspirin and heparin per Dr and my preceptor said what kind of MI? Then he explained this quick and I was sort of in shock. I had no idea it made a difference. Great video. I subscribed. Awesome resource.
The research on this topic suggests we should continue giving nitro regardless. The hypothesis is reasonable but in practice there doesnt seem to be the dangerous drop in preload that this line of reasoning suggests. Of course always follow your protocols.
Exactly. At the very least the drop in blood pressure does not seem to be significantly different when comparing myocardial infarction w/ right ventricle involvement with myocardial infarction w/o right ventricle involvement.
From a physiologic standpoint I can see how it became a recommendation. However, if you have a patient with a myocardial infarction largely affecting the left ventricle and you give nitroglycerin, then you reduce venous return to the right ventricle and reduce right ventricle cardiac output. The preload of the left ventricle is largely dependent on the right ventricle cardiac output so why isn't the same recommendation made for this instance if we're looking at it from a physiologic standpoint?
I would like to know how many deaths caused by home ntg being taken prior to Ems arrival
It's great to be a part of presentation,the total functional output of stroke volume of heart but we are not able to forecast which veinlet will be having obstacle or the maun portion may be Myocardium space will be hindered,the next stroke will also produce depression or such,so on the next phenomenon the output will be chaining.
Well said, thank you for the explanation! Always a great job :)
Why are we concerned about RV and not LV?
Well perhaps considering the RV is not very strong and is really dependant on preload for volume whereas the LV has 6 times the muscle as the RV (so I believe)
Lead I is not high lateral. That’s aVL. Nice presentation though. And yes you can see reciprocal change in both of the leads.
Lead I and lead aVL are collectively referred to as high lateral. That's why high lateral STEMI is often referred to as South African Flag sign.
Thanks for a great video.
In my service (where tablet GTN is administered sublingually) inferior STEMI is not a contraindication.
Instead it is contraindicated for hypotension or extremes of heart rate, presumably for the similar reasons (decreased preload) as inferior MI is a contraindication in many services as discussed in this video.
I was also told by instructors to consider withholding it for posterior MI but again, not a contraindication where I work.
What are your thoughts on using BP and HR as the main guide for withholding GTN instead of the 12-lead results? Is it possible/likely for a patient to be having an inferior and/or posterior MI and still have BP and HR between the flags? If so, do you think it would still be risky giving GTN in such a situation?
Hey man, what software do you use to make these videos? This is exactly what I'm going for.
Great explanation!
Thanks you, big test tomorrow!
always great learning form you Geoff!
Thanku so much sir really I understood very clearly
Very well explained
Vary useful vdeo