NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5312

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 01/10/98

1. Class:

1. Nitrate.

2. Indications:

1. Unstable Angina Pectoris.
2. Chest pain of suspected cardiac origin.
3. Hypertensive emergency.
4. Acute CHF / Pulmonary edema.

3. Therapeutic Effects:

1. Peripheral vasodilatation and decreased pre-load.
2. Decreases myocardial workload and oxygen demand.

4. Contraindications:

1. Absolute:

1. Hypersensitivity.
2. Patients less than 12 years old.
3. Cerebral hemorrhage.
4. Head injury.

1. Relative:

1. Blood pressure less than 100 systolic.

5. Adverse Effects:

1. Transient hypotension and dizziness.
2. Temporary pulsating headache.
3. Facial flushing and burning under the tongue..
4. Weakness and nausea.

6. Administration and Dosage:

1. Sublingual Only: 0.4 mg ( 1/ 150 gr. ) tablets, or metered-dose spray; repeat every 3-5 minutes if discomfort is unrelieved and systolic blood pressure remains greater than 100.

7. Special Information:

1. Age increases hypotensive response
2. Patient should be supine or semi-fowlers position during administration.