Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Corrections of Misleading Charts Comment – Part III

Continued from Corrections of Misleading Charts Comment – Part I and Corrections of Misleading Charts Comment – Part II.

3. Giving NTG to a hypotensive patient who DOES have CHF.

Is this inappropriate?

No.

If we believe that we have caused the hypotension by giving NTG (NiTroGlycerin) to a CHF (Congestive Heart Failure) patient, then the answer would be, Yes. Much more likely is that we have a patient who was initially hypotensive. That is – before we ever met the patient, he was hypotensive.

Would it be a mistake to treat this hypotensive CHF patient with NTG?

No.

In Most Survive with Mystery Treatment for Cardiac Arrest, I wrote about patients with no detectable blood pressure resuscitated with . . . . ?

If NTG is so practically death by ridiculously excessive hypotension, how do most of these patients with no detectable blood pressure improve after NTG?

NTG is supposed to be the final nail in the coffin.

The straw that breaks the camel’s back.

The coup de grâce.

After NTG, these patients are just mostly dead, they are all dead.

At least, that is if we believe the things we are told about NTG and hypotension.


Click on the image to make it larger.

This is what I posted in Most Survive with Mystery Treatment for Cardiac Arrest.

The drug is high-dose NTG.

High doses of NTG were used in 22 patients, including 14 patients with acute MI and eight patients with advanced HF. All patients had critically low BP measured by cuff, and 18 had an unmeasurable BP and pulse. They all had cold and mottled skin and increased central venous pressure. Eleven patients had rales in the lungs, three had pulmonary edema, and one had anasarca. The doses of NTG used in each patient, as well as the times of infusions, are listed in Table 1. BP became obtainable or increased in 20 of 22 patients immediately after intravenous NTG was administered. In the end, 13 patients survived.[1]

If we believe the NTG = hypotension fear mongers, the number surviving to discharge would be zero.

If we believe the NTG = hypotension fear mongers, the percent surviving to discharge would be zero.

The number is 13 patients out of 22.

The percent surviving to discharge neurologically intact is 59%.

The obvious question is –

How much do we not understand Nitroglycerin?

Why do we tolerate the IRBs refusing to allow studies of this?

How ignorant do we want to be?

For Valentine’s Day maybe we should demand investigation of what is potentially the most effective drug for resuscitating the heart.

Footnotes:

[1] High dose nitroglycerin treatment in a patient with cardiac arrest: a case report.
Guglin M, Postler G.
J Med Case Reports. 2009 Aug 10;3:8782.
PMID: 19830240 [PubMed – in process]

Free Full Text from PubMed Central . . . . . Free Full Text PDF from PubMed Central

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