Hello everyone! We just wanted to take a moment to thank all of our viewers for watching our videos with scrutiny. This Oral Board video is a replacement due to a good catch by a viewer who notified us something was missing. So we looked into it, it was a simple fix in the edit that got left out, and this new video is up as a result. Accuracy is key for us at PSESI and we encourage your comments. Learn, share, and save some lives!
@@drummaboy303 I was stressed on the day, but in every skill station my stress disappeared as I performed. I felt prepared. I think the static and IOOH are the only two areas that are more difficult than the EMT. Other than that if your good on your EMT skills the other areas are less difficult I think.
He still said he’d be considerate since it’s an inferior. It’s the same approach. Any inferior regardless of V4R you’re going to keep an extra careful eye on that pressure.
He had large bore, ready for bolus and rapid transport. V4R would be nice. He was cautious. Before 12 lead it was commonly given just have a line for fluids.
With an Inferior MI nitro can be given if it is an LCx occlusion. Deeper reciprocal changes in aVl with the same amplitude of ST elevation in leads II and III. May see lateral involvement with the distal LCx occlusion
Good job - O2 right away some places hold if 94, but this was clearly indicated. I would verbalise check ankle edema, Jvd, maybe Opqrst for pain. Good concise decision making - I like it !
Thank you very much for these videos. One thing, though; the background music during the scenarios is incredibly distracting! Really do appreciate the videos to help me prep for testing next week!
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
Thank you so much for this video! Its a huge help! I take my psychomotor in a couple months here in florida. There's no real way to get information on how to test as we aren't required to be nationally certified, so this video is a serious life saver. I really hope to see some more example videos like this for different scenarios soon! Thanks again for making these videos!!!
Yeah that’s the only thing I was thinkin. I’m always afraid to comment because I could be wrong lol. So you guys think a right sided 12lead would have been appropriate?
@@carolinemorris9620 it’s appropriate but he still treated it the same way as if he’d checked it. You withhold nitro in a textbook based scenario you’re still going to fail. So it’s like.. just be considerate.
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
@@carolinemorris9620 yea place v4 lead on the opposite side of the chest. If you see elevation on that twelve lead. Don’t give nitro prior to consultation with the hospital.
I would still ask "Is the scene safe?" rather than just asking about "concerns". Also.. it was verbalized it was 110 degrees out.. was the home air conditioned? Pt drinking fluids? Urination (intakes and outputs?) Nothing like bringing a cardiologist a STEMI patient with huge electrolyte imbalances to boot. Love the tips and scenarios though so keep them coming.
Depends on your protocols but in many protocols NTG isn't an absolute contraindication during, just a precaution. NTG causes vasodialation which reduces preload, which tanks blood pressure, so it's theoretically safe as long as they have a blood pressure that can handle the reduction. His SBP was 150 and was reassessed right after NTG admin. Also, in his report he states they "cautiously gave NTG". I'd have stated this was like a posterior MI, (still suffers from preload reduction).
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
He starts off with stating how he'd proceed to the call (basic code 3 driving) even though the proctor has stated he is on scene as he sees the pt as he approaches. Is this narration of code 3 response a necessary step? I have 1 oral station retest to do.. trying to figure out how to crush the retest
Same here. My proctor told me the same thing as this one did in the video you are on scene etc. I will say for anyone taking the oral station. Take your time. Its so easy to get tunnel vision and miss minor details even if your scenario improves and patient outcome improves.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
Love the videos, but why did he not proceed to administer pain medication to decrease the patients pain to a zero. he has 10 minutes until arrival at ED and had another dose of nitro he could have administered and went on to morphine or fentanyl. Just how my brain was working.
If I’m not mistaken he was giving a report to medical control or something and was just giving them a heads up on his interventions he had already taken. The skill is over after this, but in real life he would have proceeded with a third dose of Nitro, and possibly morphine if need be.
I would not give ntg with inferior MI because there is probable R sided ventricular involvement. in a recent study 60% of patients develop hypotension with inferior MI's so giving ntg can dangerously dump their pressure, and why do you ask about airway and breathing after you ask about cardiac stuff
Am I missing something? You must ask about ED's before you give nitro.....It's disturbing that they present this video as a study guide and so many people are saying 'great job'.
You've identified a STEMI and you're not using tenecteplase? Also, do you not verbalise that you've checked the Nitro tablets? Bottled Nitro tablets are good for 3 months after opening, but only 2 if working in a hot climate. When we used the tablets we'd have to write the date of opening. We stopped using them about 15 years ago in favour of GTN spray (the little red bottles). I didn't hear the 5 or 6 rights of drug administration verbalised. Greetings from an Australian paramedic since '98.
90% of our ground, non-critical care services in the US do not carry TNKase. Would be awesome if they did, but it's just not available the way it is in your country. Flight and critical care units have it, as well as Heparin, and they often make use of it. Working where I do, it would be great to have some form of thrombolytic, being as we are very rural. But the issue remains that the profession itself is hindered by its weakest practitioners. All it takes is one medic giving a thrombolytic to a hemorrhagic stroke, or a hemophiliac with early repolarization rather than ST elevation. They'd rather not take that chance, so we don't get the cool toys. Same reason non-critical care units generally don't have access to blood products, surgical crics, chest tubes, and central lines. It does vary by state; however, and some places have very forward-thinking, aggressive protocols allowing some of the above mentioned skills and drugs.
Why check a finger stick blood sugar when the patient is not altered, fully awake, alert and oriented, has no history of diabetes, no history of insulin use and no indications for the check?
Do you do videos on some of the terms used in these videos, or does anyone know where I can find videos or books explaining common terms paramedics use, honestly I had no clue what some of the things mentioned in the video were and I am really interest in learning about what it takes to become a paramedic.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
Did they change the Sp02 rang recently? Im an EMT Offshore in CA and ive always followed the rang of normal SP02 96%-99% not 94%-98% and workable 02 needs to be maintained above >96% Also ED drugs and the L and M in SAMPLE? I didn't hear him ask about current meds/ contraindication investigation? good video though
That could be your state guideline. NREMT for both EMT and PARAMEDIC are >94% for almost any medical case. The normal range should be 94-99. In this situation the ACLS algorhythm is the standard.
II. Oxygenation of chest pain and stroke patients a. 2 L/min via nasal cannula for patients who i. Complain of dyspnea ii. Experience signs and symptoms of shock iii. Experience heart failure iv. Have an SpO₂ of less than 94% (on room air) b. Titrate oxygen to maintain an SpO₂ of at least 94% You are correct sir!! 2016 NREMT Guidelines NCCP pg. 7 (but why does he want to stop at 98%? is there a reason?) BUT what about the Erectile Dysfunction or the Last Oral Intake or Current Medication ?? Hypothetically couldn't that be a critical fail for not taking proper precautions before giving a drug intervention?
@@eduardodiaz9354 So in the field everyone you've come into contact with with an SP02 of 99%, and short of breath you've given oxygen?? You sir are high or do not work in the field.
Ok, in Massachusetts you do not give pts O2 if they do not need it. And obviously I am assessing my pt because if they are short of breath and they are a psych I am not giving them 15 lpm via nrb to a pt. At MOST I am giving them 2 lpm via nasal. MAYBE. No reason to give them o2. That's foolish
Interesting conversations here. Let's look at this in a real time situation. If a patient is short of breath, giving oxygen is going to be priority (obviously). While you're unwrapping the nasal cannula/O2 mask and getting it ready, why not get your partner to put the sats probe on? At the end of the day, treating dyspnoea is more important than getting an RA sats reading.
Ccavazo Just my 2 cents worth, but if a patient is short of breath, they need O2-period. There's a big difference between a well perfused psych patient who's got a RR of 40 because they're just hyperventilating, and a dyspnoeic patient. Don't forget too that psych patients can get DKA, PE, HI or all the other triggers for hyperventilation. To suggest that all hyperventilating psych patients is just psychogenic is poor clinical assessment. And that (to use your words) "that's foolish".
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
I\'m not sure but ,if anyone else trying to find out emt testemt test prep try Nadazma Paramedic Helper (do a search on google ) ? Ive heard some decent things about it and my mate got great results with it.
Nitro is not contraindicated in inferior MI; not even in right ventricular inferior MI. You are to use caution when administering it, and should have IV access established, and be prepared to administer a fluid bolus as well. Countless studies have shown that, so long as the initial pressure isn't borderline hypotensive, there isn't a profound risk of hypotension due to nitro administration. The only direct contraindications for nitro administration are hypersensitivity, ED med use (Viagra, Cialis, etc.), and a BP
not contraindicated with a V4R negative, only with a V4R positive is it contraindicated. However, the tester never did a V4R to confirm or deny elevation or depression
@@jeremy5853 V4R just confirms RVI and not absolute contraindication as long as you have adequate BP (* based on your local protocols & contraindications); here in WNY, as long as systolic is >120 we can give it q5mins as needed but protocol also suggests doing V4R to confirm if RVI is present in setting of inferior MI and if they become hypotensive, lay flat &/or fluid bolus (*assuming no rales) but thats just us. Could be totally different across country re Nitro use/contraindications * see above "applesauce" as several good points are made
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration. The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle. I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
This helped me get perfect scores in the Oral stations and helped me pass the paramedic psychomotor on my first attempt
Hello everyone! We just wanted to take a moment to thank all of our viewers for watching our videos with scrutiny. This Oral Board video is a replacement due to a good catch by a viewer who notified us something was missing. So we looked into it, it was a simple fix in the edit that got left out, and this new video is up as a result. Accuracy is key for us at PSESI and we encourage your comments. Learn, share, and save some lives!
Passed my test on Feb 6th, 2021. Your videos helped me a bunch. I love your teaching methods. Your online lectures are awesome big thanx!!!!
did you find the test difficult the entire psychomotor?
@@drummaboy303 I was stressed on the day, but in every skill station my stress disappeared as I performed. I felt prepared. I think the static and IOOH are the only two areas that are more difficult than the EMT. Other than that if your good on your EMT skills the other areas are less difficult I think.
Excellent and thorough job! Just a question out of my own curiosity: Why not check a V4R with the presence of an inferior MI, prior to giving nitro?
He still said he’d be considerate since it’s an inferior. It’s the same approach. Any inferior regardless of V4R you’re going to keep an extra careful eye on that pressure.
He had large bore, ready for bolus and rapid transport. V4R would be nice. He was cautious. Before 12 lead it was commonly given just have a line for fluids.
With an Inferior MI nitro can be given if it is an LCx occlusion. Deeper reciprocal changes in aVl with the same amplitude of ST elevation in leads II and III. May see lateral involvement with the distal LCx occlusion
Good job - O2 right away some places hold if 94, but this was clearly indicated. I would verbalise check ankle edema, Jvd, maybe Opqrst for pain.
Good concise decision making - I like it !
Thank you very much for these videos. One thing, though; the background music during the scenarios is incredibly distracting! Really do appreciate the videos to help me prep for testing next week!
We will scale it back,
I also agree and maybe invest in a tripod or steady handed camera man
I would’ve moved V4 over to see if there’s right sided involvement, definitely do NOT want to give Nitro then.
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
Thank you so much for this video! Its a huge help! I take my psychomotor in a couple months here in florida. There's no real way to get information on how to test as we aren't required to be nationally certified, so this video is a serious life saver. I really hope to see some more example videos like this for different scenarios soon! Thanks again for making these videos!!!
Thank you for posting this video! Very helpful.....
Ps.
Is there music playing in the background? ...the audio quality was very distracting
Shouldn’t you have checked for right sided involvement prior to administering Nitro?
yes, exactly...was waiting for v4r but never done
Yeah that’s the only thing I was thinkin. I’m always afraid to comment because I could be wrong lol. So you guys think a right sided 12lead would have been appropriate?
@@carolinemorris9620 it’s appropriate but he still treated it the same way as if he’d checked it. You withhold nitro in a textbook based scenario you’re still going to fail. So it’s like.. just be considerate.
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
@@carolinemorris9620 yea place v4 lead on the opposite side of the chest. If you see elevation on that twelve lead. Don’t give nitro prior to consultation with the hospital.
I would still ask "Is the scene safe?" rather than just asking about "concerns". Also.. it was verbalized it was 110 degrees out.. was the home air conditioned? Pt drinking fluids? Urination (intakes and outputs?) Nothing like bringing a cardiologist a STEMI patient with huge electrolyte imbalances to boot. Love the tips and scenarios though so keep them coming.
If you have an inferior MI would you not perform a right sided 12 lead to rule that out? NTG is contraindicated if it's a right sided MI
i know i would for sure.
Depends on your protocols but in many protocols NTG isn't an absolute contraindication during, just a precaution. NTG causes vasodialation which reduces preload, which tanks blood pressure, so it's theoretically safe as long as they have a blood pressure that can handle the reduction. His SBP was 150 and was reassessed right after NTG admin. Also, in his report he states they "cautiously gave NTG". I'd have stated this was like a posterior MI, (still suffers from preload reduction).
@@ModemX17 This is National Registry, Local Protocols go out the window.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
Awesome videos. Love the mock ambulance box you have set up.
Wouldn't it be 324 mg (4 × 81mg chewable baby aspirin)? Or do they have 325 mg chewable aspirin now? I know one adult aspirin is 325 mg
Both. Depends on the agency.
He starts off with stating how he'd proceed to the call (basic code 3 driving) even though the proctor has stated he is on scene as he sees the pt as he approaches. Is this narration of code 3 response a necessary step? I have 1 oral station retest to do.. trying to figure out how to crush the retest
Same here. My proctor told me the same thing as this one did in the video you are on scene etc. I will say for anyone taking the oral station. Take your time. Its so easy to get tunnel vision and miss minor details even if your scenario improves and patient outcome improves.
did i miss the pt's history and meds? or did that not get asked?
Don’t forget to consider having pads on this patient and check for right side involvement 😊
Depressions in septal and anterior Leads, wouldn't we consider posterior involvement as well? And check with posterior 12 lead?
No, depression doesn't constitute infarction, if there were inverted T waves then you would know that those areas were becoming ischemic.
Posterior would have been a good idea in general due to the inferior elevation
thank you very much for the awesome video
Hello! Do you guys have any more detailed information about how to take notes for an oral board like this? Thanks
I like this video. You should do a pediatric scenario for an Oral Station... specifically including the Parkland formula and BSA!
Why is there background music?
Consider morphine for CP for inferior MI, nitro is risky, they depend on that preload.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
Love the videos, but why did he not proceed to administer pain medication to decrease the patients pain to a zero. he has 10 minutes until arrival at ED and had another dose of nitro he could have administered and went on to morphine or fentanyl. Just how my brain was working.
If I’m not mistaken he was giving a report to medical control or something and was just giving them a heads up on his interventions he had already taken. The skill is over after this, but in real life he would have proceeded with a third dose of Nitro, and possibly morphine if need be.
Great training! Thanks
I would not give ntg with inferior MI because there is probable R sided ventricular involvement. in a recent study 60% of patients develop hypotension with inferior MI's so giving ntg can dangerously dump their pressure, and why do you ask about airway and breathing after you ask about cardiac stuff
Am I missing something? You must ask about ED's before you give nitro.....It's disturbing that they present this video as a study guide and so many people are saying 'great job'.
You've identified a STEMI and you're not using tenecteplase?
Also, do you not verbalise that you've checked the Nitro tablets? Bottled Nitro tablets are good for 3 months after opening, but only 2 if working in a hot climate. When we used the tablets we'd have to write the date of opening. We stopped using them about 15 years ago in favour of GTN spray (the little red bottles). I didn't hear the 5 or 6 rights of drug administration verbalised.
Greetings from an Australian paramedic since '98.
90% of our ground, non-critical care services in the US do not carry TNKase. Would be awesome if they did, but it's just not available the way it is in your country. Flight and critical care units have it, as well as Heparin, and they often make use of it. Working where I do, it would be great to have some form of thrombolytic, being as we are very rural. But the issue remains that the profession itself is hindered by its weakest practitioners. All it takes is one medic giving a thrombolytic to a hemorrhagic stroke, or a hemophiliac with early repolarization rather than ST elevation. They'd rather not take that chance, so we don't get the cool toys. Same reason non-critical care units generally don't have access to blood products, surgical crics, chest tubes, and central lines. It does vary by state; however, and some places have very forward-thinking, aggressive protocols allowing some of the above mentioned skills and drugs.
Why check a finger stick blood sugar when the patient is not altered, fully awake, alert and oriented, has no history of diabetes, no history of insulin use and no indications for the check?
Do you do videos on some of the terms used in these videos, or does anyone know where I can find videos or books explaining common terms paramedics use, honestly I had no clue what some of the things mentioned in the video were and I am really interest in learning about what it takes to become a paramedic.
Become an EMT first. The terms will become easier that way
Should you of check V4R since the Pt 12-lead showed an inferior MI ?
Allen McChancey yeah absolutely. Especially if you are considering giving nitro.
Going through paramedic school anything on the right skip the nitro and keep a slow fluid running and to ensure preload stays stable
That guy's head reminds me of yours, Allen.
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
Did they change the Sp02 rang recently? Im an EMT Offshore in CA and ive always followed the rang of normal SP02 96%-99% not 94%-98% and workable 02 needs to be maintained above >96%
Also ED drugs and the L and M in SAMPLE? I didn't hear him ask about current meds/ contraindication investigation?
good video though
That could be your state guideline. NREMT for both EMT and PARAMEDIC are >94% for almost any medical case. The normal range should be 94-99.
In this situation the ACLS algorhythm is the standard.
II. Oxygenation of chest pain and stroke patients
a. 2 L/min via nasal cannula for patients who
i. Complain of dyspnea
ii. Experience signs and symptoms of shock
iii. Experience heart failure
iv. Have an SpO₂ of less than 94% (on room air)
b. Titrate oxygen to maintain an SpO₂ of at least 94%
You are correct sir!! 2016 NREMT Guidelines NCCP pg. 7 (but why does he want to stop at 98%? is there a reason?)
BUT what about the Erectile Dysfunction or the Last Oral Intake or Current Medication ??
Hypothetically couldn't that be a critical fail for not taking proper precautions before giving a drug intervention?
94 percent is typically used due to the oxygen-hemoglobin dissociation curve.
Why is he giving oxygen before obtaining an initial SP02??
Ccavazo you’re stupid if you need to check spo2 before giving oxygen he clearly said the patient has shortness of breath
@@eduardodiaz9354 So in the field everyone you've come into contact with with an SP02 of 99%, and short of breath you've given oxygen?? You sir are high or do not work in the field.
Ok, in Massachusetts you do not give pts O2 if they do not need it. And obviously I am assessing my pt because if they are short of breath and they are a psych I am not giving them 15 lpm via nrb to a pt. At MOST I am giving them 2 lpm via nasal. MAYBE. No reason to give them o2. That's foolish
Interesting conversations here.
Let's look at this in a real time situation. If a patient is short of breath, giving oxygen is going to be priority (obviously). While you're unwrapping the nasal cannula/O2 mask and getting it ready, why not get your partner to put the sats probe on?
At the end of the day, treating dyspnoea is more important than getting an RA sats reading.
Ccavazo Just my 2 cents worth, but if a patient is short of breath, they need O2-period. There's a big difference between a well perfused psych patient who's got a RR of 40 because they're just hyperventilating, and a dyspnoeic patient. Don't forget too that psych patients can get DKA, PE, HI or all the other triggers for hyperventilation. To suggest that all hyperventilating psych patients is just psychogenic is poor clinical assessment. And that (to use your words) "that's foolish".
No V4R? And not asking if he takes viagra? Your patient has died lol
Recent retrospective studies show left sided MIs have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior MIs with right ventricular involvement.
NO nitro on inferior MI
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.
I\'m not sure but ,if anyone else trying to find out emt testemt test prep try Nadazma Paramedic Helper (do a search on google ) ? Ive heard some decent things about it and my mate got great results with it.
Giving nitro to a patient with an inferior MI isn't a critical fail for NREMTP??
Nitro is not contraindicated in inferior MI; not even in right ventricular inferior MI. You are to use caution when administering it, and should have IV access established, and be prepared to administer a fluid bolus as well. Countless studies have shown that, so long as the initial pressure isn't borderline hypotensive, there isn't a profound risk of hypotension due to nitro administration. The only direct contraindications for nitro administration are hypersensitivity, ED med use (Viagra, Cialis, etc.), and a BP
not contraindicated with a V4R negative, only with a V4R positive is it contraindicated. However, the tester never did a V4R to confirm or deny elevation or depression
@@AppleSauce123 Very well stated!
@@jeremy5853 V4R just confirms RVI and not absolute contraindication as long as you have adequate BP (* based on your local protocols & contraindications); here in WNY, as long as systolic is >120 we can give it q5mins as needed but protocol also suggests doing V4R to confirm if RVI is present in setting of inferior MI and if they become hypotensive, lay flat &/or fluid bolus (*assuming no rales) but thats just us. Could be totally different across country re Nitro use/contraindications * see above "applesauce" as several good points are made
Why would you give Nitro to an Inferior MI? They rely so heavily on preload. I would have failed you.
I’ve always been told nitro is ok for inferior, as long as b/p is ok, and monitor closely.
As long as you have a IV established to give a bolus if needed. More important to get some vasodilation. It's ACLS .
Recent retrospective studies show left sided Mis have about the same incidence of significant BP drop after Nitro administration.
The only absolute contraindication for Nitro that I am aware of are allergic to Nitro, hypotension, and or the recent use of ED drugs. To withhold Nitro for any other reason may unnecessarily sacrifice cardiac muscle.
I humbly suggest you check with your medical director for his/her directions on whether to withhold Nitro for inferior Mis with right ventricular involvement.