โ Scribed by Jonathan Wasserberger; Subramaniam Balasubramaniam
No coin nor oath required. For personal study only.
Bussman and Schapp demonstrated the dramatic beneficial effects of sublingual nitroglycerin in the emergency treatment of severe pulmonary edema. Studies have been proposed to determine the efficacy and role of sublingual nitroglycerin in the prehospital management of pulmonary edema by paramedic rescue squads (personal communication, J. Hoffman, Coordinator of Prehospital Research, EMS Subcommittee, Department of Health, County of Los Angeles, January 4, 1981). The results of this study should have a major impact on the prehospital management of pul-m0nary edema in Los Angeles County.
We would like to report two cases that demonstrate a major complication in the prehospital use of sublingnal nitroglycerin.
Case Number One. A 57-year-old male paraplegic Complained of shortness of breath and epigastric pain for 2V2 hours. The patient was alert, with normal skin color; he had a blood pressure of 102/76; pulse, 96; and respirations, 26. Skin temperature was not reported. Neck veins were flat. The patient was bringing up copius white, frothy sputum. Wheezing was present bilaterally and the paramedics reported that the lungs sounded "wet." The ECG showed sinus tachycardia at ll0/min without ectopy. On the presumptive diagnosis of pulmonary edema, 02 was started at 4 L/min and the MICN ordered one nitroglycerin tablet 1/150 sublingually followed by D5W-KVO and furosemide 40 mg IV. The nitroglycerin was given sublingually; however, because the IV infiltrated, the furosemide was administered IM. Within 5 minutes the blood pressure dropped to 60 palpable and the pulse rose to 114. The patient was placed in the supine position. On arrival 5 minutes later with a blood pressure of 80/100, he was alert and his skin was pink. Normal saline (200 cc)raised the blood pressure to 96/60 and the patient remained stable. A chest film revealed pneumonia rather than pulmonary edema. The patient was hospitalized. The dehydration was complicated by the relative chronic volume-depleted state of the underlying paraplegia.1
Case Number Two. A 64-year-old, 150-1b man complained of chest pain radiating through to the back accompanied by shortness of breath. The patient had a past history of myocardial infarction. He was reported by the paramedics to be "moist," with a blood pressure of 154/80;
๐ SIMILAR VOLUMES
Recent studies suggest that medical professionals may perform better external CPR than do nonprofessional citizens. Professional bystander CPR performed by two distinct groups was studied retrospectively, first with fire department first-responder basic EMTs and then with physicians, nurses, and oth