Can an EMT-B give nitroglycerin to some one w/ high blood pressure?

The patient's vital signs include: (male, 49 yrs old) blood pressure is 140/90mm Hg w/ a heart rate of 110 beats/min. Complains of crushing chest pain and shortness of breath, is pale and diaphoretic and says that he feels like he is going to die.

What would I do after I administering 100% oxygen? Would I get a physician's approval to give the nitro, or place him in a supine position and transport at once, or administer one nitroglycerin and called medical control, or ask him if he took his viagra within the past 24 hrs.

I can't figure this question out.

Serious answers only please, thanks.

Dana M is exactly correct.

You need to ensure that the Pt did not take any ED meds since the combination of the ED med and the nitro can drop the BP severely (ED meds dilate the vessels in the lower body- Nitro in the upper body).

I wouldn't place them supine since BP is not low. I'd leave them in the positon of comfort.

Calling medical control may be necessary based on where you are, but in any case- you need to find out if any ED meds were taken before contacting them.

Last thing, I'm pretty sure EMT-B's can assist with nitro in all but the most conservative of areas. The problem comes when they don't have nitro prescribed to them. It's their spouses or friends in which case you cannot assist with it.

Gary S is right that you should call an ALS intercept but that's about it. You should not administer O2 via nasal cannula. Every Pt should get 15 LPM via non-rebreather (100%, like you said), according to the book (this will change in the field, I assure you).

Being pale and diaphoretic does not necessitate the he be transported supine. The fact that you don't have the capability to start an IV should not affect your decision to give nitro. If he needs it, he gets it and based on your assessment he does.

You must also determine how many Nitro the Pt has already taken.

One last consideration that I'm sure you're aware of is that you do not administer nitro to Pt's with a BP less than 100 systolic due to the resulting drop.

After administering continue to assess the Pt's BP and ensure that it has not dropped too low.

Hope that helps.

Before giving NTG you must determine the pt. hasn't taken Viagra (or other ED drug) in the last 24hrs. Also, laying supine isn't needed, B/P is stable. Give NTG after asking about Viagra would be my answer and I was a medic, ED nurse and now a practicing PA. The NTG is indicated b/c of the CP and the pt. has a high B/P which the NTG should bring down and thus improve coronary artery circulation to improve blood flow to the myocardium. Good luck, hope that helps.

In your case there are a few things to consider here:
As a EMT Basic my first question would be is there a EMT Intermediate or Paramedic unit available now to come and assist on this call.
YOU ARE NOT THE RIGHT PERSON TO BE ON SCENE TREATING THIS PATIENT
If the answer is no then you have to treat and transport rapidly to a hospital. YES lay the patient down, as he is pale and diaphoretic, actuallly he should be in a fowlers postion (sitting up) and place oxygen on him at 2 liters per minute via nasal cannula.
If the patient has nitro, you can assist in him taking it, in an attempt to help relieve his chest pain, yes ask about any erectile dysfunction meds(viagra).
BEAWARE NITRO CAN CAUSE SEVERE HYPOTENSION. This is why it is always good to have a working IV prior to giving nitro, as bad things can happen, even cardiac arrest (what happens if he lies about viagra?) Now you have to scramble to get a line if you have the skill to do this and most EMT-B do not, so then you are really screwed, as you now have a patient in caediac arrest and no way to help him rather than CPR and a fast ride to hospital.
If they just go hypotensive (after nitro administration) and no line then you need to put the patient into a trendelenburg postion to help increase blood flow to brain and body core in hope to increase bp.
while this is going on you should be transporting patient to hospital reapidly, as he may be having an MI and his only hope of survival is either thrombolitics or cath lab.