Nitro paste is NOT an emergency medicine drug – The Evidence

I have no idea why, but many paramedics clamor for including nitroglycerin paste in their drug bag. Baffles me. True, you don’t need to break the seal of the CPAP to give it, and you don’t need to use an IV. But this medication hardly belongs in the emergency department, let alone a 21st-century EMS rig. Before I get to the most recent evidence, I first want to highlight this perspective about why prehospital use of paste doesn’t make sense. Rant! First off, let me ask: In what other medical emergency, where a patient is diaphoretic, ghost-white, and tachy-crazy, do we apply an ointment – stat! Stat! And why not? Because we already know that pharmacokinetics proves that this is not a “stat!” kind of drug: Nitro paste takes a looong while to reach a peak level (about 60 minutes), and You end up with pretty weak blood levels with paste. Like, 18 times lower blood levels, compared with IV. So maybe a poultice of nitroglycerin and tail-of-toad was all the rage back in 1780, but we’ve made a few other medical advances since then… Well, this was genius. But the rest of the medicine was garbage back then. But even more importantly, dosage is measured in inches?!? No other medication is measured this way! Even in the 19th century, the commonly prescribed (and completely toxic) mercury pills were prescribed in precise weights (e.g. 1 grain). Even if we don’t dose nitro paste in milligrams, you would at least expect that a liquid drug would be dispen...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Dogmalysis Pharmacology Source Type: research