ERcast - Lit Matters: What If We Give Nitrates To A Right-Sided MI?

Is it time to let sleeping dogma lie? Historically we've been taught to avoid using nitrates if a patient has signs of a right-sided MI. Watch as Drew Kalnow and Cam Berg pull back the curtain on this long-held teaching and find a simple, evidence-based path forward!
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[@Ali_king7Taro]

Thanks guys for highlighting this issue!

[@wendellhoward884]

Thank you for researching this topic. The impact of this Nitro phobia potentially prevented treatment to AMIs.
The review of the data is greatly appreciated.
Have you considered the topic of adenosine for SVT due to WPW. Here in Central Indiana some medical directors are stating WPW is a contraindication for adenosine.

[@jamesdesrochers438]

One of the big reasons is because WPW is an AVRT not AVNRT, by blocking the AV node all your doing is sending conduction down an unregulated accessory pathway which can get bad if the pt has multiple accessory tracts. Still may be safely effective in some narrow complex but still gotta be careful and make sure theres not an underlying afib, have you been successful with adenosine/wpw svt in the past?

[@wendellhoward884]

@@jamesdesrochers438 Thank you for your reply and contrasting AVRT vs AVNRT. Yes I have been successful with SVT and history of WPW. But I am cautious about drawing "facts" from my practice solely on my paramedic anecdotal experience. And I teach my paramedic students about the dangers of A-Fib RVR and history of WPW.
When I ask medical directors about WPW as a contraindication in the protocols, I finally received a legitimate answer from a respected ED physician. I introduced my questions with the FDA and drug manufacturer's approval of adenosine for WPW SVTs. She honestly responded, "that is how I was taught in medical school."
I try not to teach dogma and share both sides of the opinion, and unfortunately many times I am warning the students about how anecdotal information is becoming "fact." Any more insights you have to share I pass on to the new generation of paramedic students.

[@mdmuzammilkhan7063]

Could anyone provide an explanation and description of the Ferguson 1989 papers?

[@Idre37]

I always felt it was hogwash... like so many things in medicine:)