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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How Can Chest Pain Be Treated?

I am a traveling nurse on a tele unit and saw that one of our patients was in trouble with chest pain asking for a nitro. I have 22 years CCU experience. His nurse would not give it to him stating that he had the allotted 3 pills in the last 24 hours and that s all he can have. This seems to be a floor policy of which I have never heard. He is 87 y/o, DNR, and takes nitro at home to control his chest pain. They gave morphine 2 mg which didn t help. He became diaphoretic, legs mottling, short of breath. BP managed to be at 110. He kept asking me why he can t have his nitro and he was dying. He also just went into Afib rate of 140 and they were more concerned about getting a cardiazem gtt started than managing his pain. 12 lead showed ST depression. I know nitro can be given per emergency protocol every 5 min. x 3. Watching the BP. If that doesn t work we go to morphine, then usually ship them off to the cath lab. What should we have done in his case? What is the maximum number of nitro you can have in a day if your BP allows and the nitro is effective in relieving the pain? I felt we did this man a huge disservice.
Mon, 22 Oct 2018
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General Surgeon 's  Response
Hi,

He can take Nitro if the blood pressure is normal.

Most importantly he needs ICU care with cardiac monitoring. Most probably it will be a cardiac pain and proper treatment is necessary.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Shinas Hussain,
General & Family Physician
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How Can Chest Pain Be Treated?

Hi, He can take Nitro if the blood pressure is normal. Most importantly he needs ICU care with cardiac monitoring. Most probably it will be a cardiac pain and proper treatment is necessary. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Shinas Hussain, General & Family Physician