Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis

Popp, Lucas M.; Lowell, Luke; Ashburn, Nicklaus P.; Stopyra, Jason P.

doi:10.1016/j.ajem.2021.08.006

Cited by 4 publications

(18 citation statements)

References 24 publications

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“…For example studies has shown that short term “over treatment” with oxygen do not affect patient outcome [ 26 ]. Furthermore, prehospital treatment with acetylsalicylic acid [ 27 ] or sublingual glyceryl trinitrate [ 28 ] are rarely associated with adverse events. In addition, the identified associations between guideline adherence and age, sex and AMI are of interest regardless of if “over treatment” is at hand or not.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

Wibring

Lingman

Herlitz

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The emergency medical services (EMS) use guidelines to describe optimal patient care for a wide range of clinical conditions and symptoms. The intent is to guide personnel to provide patient care in line with best practice. The aim of this study is to describe adherence to such guidelines among prehospital emergency nurses (PENs) when caring for patients with chest pain. Objective To describe guideline adherence among PENs when caring for patients with chest pain. To investigate whether guideline adherence is associated with patient age, sex or final diagnosis of acute myocardial infarction on hospital discharge. Methods Guideline adherence in terms of patient examination and pharmaceutical treatment was analysed in a cohort of 2092 EMS missions carried out in 2018 in Region Halland, Sweden. Multivariate regression was used to describe how guideline adherence is associated with patient age, sex and diagnosis on hospital discharge. Results Guideline adherence was high regarding examination of vital signs (93%) and electrocardiogram (ECG) registration (96%) but lower in terms of pharmaceutical treatment (ranging from 28 to 90%). Adherence was increased in cases in which the patient ended up with acute myocardial infarction (AMI) as diagnosis on discharge. Patients with AMI were given acetylsalicylic acid by PENs in 50% of cases. Women were less likely than men to receive treatment with acetylsalicylic acid and oxycodone. Conclusions Guideline adherence among PENs when caring for patients with chest pain is satisfactory in terms vital signs and ECG registration. Regarding pharmaceutical treatment guideline adherence is defective. Improved adherence is mainly associated with male sex in patients and a diagnosis of AMI on hospital discharge. Defective adherence excludes measures known to improve patients’ prognoses such as treatment with acetylsalicylic acid.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

Wibring

Lingman

Herlitz

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

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“…All of the studies assessed Hispanics' experiences with the EMS system in the United States, although some studies focused on the national (n = 15), 2,7,10,11,13,16,21,22,24,28,31,35,36,40,41 state (n = 11), 6,14,15,17,18,20,25,39,42,44,46 or local level (n = 17). 12,19,23,26,27,29,30,[32][33][34]37,38,45,[47][48][49] Hispanic sample size ranged from 1 to 99 (n = 4), 14,32,40,42,47 100 to 999 (n = 17), 12,18,19,27,…”

Section: Resultsmentioning

confidence: 99%

“…22,46 Among the 13 studies, 5 studies focused on pain assessment 6 and pain medication administration. 6,27,31,41,43 Hispanics were less likely to receive a pain assessment compared with non-Hispanic Whites. 6 Among patients who received a pain assessment, Hispanics reported a higher average pain score compared with non-Hispanic Whites.…”

Section: Racial/ethnic Disparities In Activation Of Emsmentioning

confidence: 99%

“…Thirteen studies assessed types of on-scene care. 2,6,12,18,19,22,27,31,33,39,41,43,46 Among these, 8 examined EMS response time, 2,12,18,33 time spent on scene, 39 prehospital recognition of symptoms 19 and administration of out-of-hospital interventions 22,33,46 between Hispanic and non-Hispanic Whites. EMS response time and return of spontaneous circulation following resuscitation were comparable between Hispanic and non-Hispanic Whites experiencing sudden cardiac arrests.…”

Section: Racial/ethnic Disparities In Activation Of Emsmentioning

confidence: 99%

“…6 The findings for pain medication administration were mixed. Two studies found that Hispanics were less likely to receive pain medication, 6,43 2 studies reported statistically nonsignificant differences in morphine 27 or nitroglycerin 31 administration, and 1 study found that Hispanics were more likely to receive aspirin, 41 compared with non-Hispanic Whites.…”

Section: Racial/ethnic Disparities In Activation Of Emsmentioning

confidence: 99%

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A Systematic Literature Review of Hispanic Adults’ Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021

et al. 2023

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Objective: This systematic literature review presents an overview of studies that assess the experiences of Hispanic adults with (1) activation of emergency medical services (EMS); (2) on-scene care provided by EMS personnel; (3) mode of transport (EMS vs. non-EMS) to an emergency department (ED); and (4) experiences with EMS before and during the COVID-19 pandemic. Methods: A bibliographic database search was conducted to identify relevant studies on Ovid MEDLINE (PubMed), Web of Science, EMBASE, and CINAHL. Quantitative, mixed methods, and qualitative studies published in English or Spanish were included if they discussed Hispanic adults’ experiences with EMS in the US between January 1, 2000 and December 31, 2021. The Hawker and colleagues quality assessment instrument was used to evaluate the quality of studies. Results: Of the 43 included studies, 13 examined EMS activation, 13 assessed on-scene care, 22 discussed the mode of transport to an ED, and 4 described Hispanic adults’ experiences with EMS during the COVID-19 pandemic. Hispanics were less likely to activate EMS (N=7), less likely to receive certain types of on-scene care (N=6), and less likely to use EMS as the mode of transport to an ED (N=13), compared with non-Hispanic Whites. During the early COVID-19 pandemic period (March to May 2020), EMS use decreased by 26.5% compared with the same months during the previous 4 years. Conclusions: The contribution of this study is its attention to Hispanic adults’ experiences with the different phases of the US EMS system.

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Safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema: A 4‐year review

Patrick,

Fornage,

Ward

et al. 2023

JACEP Open

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BackgroundIntravenous nitrates are a primary therapy for hypertensive congestive heart failure (CHF) with acute pulmonary edema (APE) in the hospital setting. Historically, sublingual nitrates are the mainstay of emergency medical services (EMS) pharmacologic therapy for these patients. We aimed to evaluate the safety of prehospital bolus dose intravenous nitroglycerin in patients with APE.MethodsThis is a retrospective evaluation of EMS data between March 15, 2018, and March 15, 2022, where CHF with APE was suspected and bolus‐dose intravenous nitroglycerin was administered. Protocol inclusion criteria were hypertension (systolic blood pressure [SBP] >160 mmHg) and acute respiratory distress, with a presumption of decompensated CHF with APE. These patients received 1 mg intravenous nitroglycerin, with the option to repeat once for ongoing distress if the SBP remained >160 mmHg. The primary outcomes were adverse events, defined as hypotension (SBP <90 mmHg), syncope, vomiting, or dysrhythmia.ResultsThe final analysis included 235 patients. In patients receiving intravenous bolus nitroglycerin, the median (interquartile range [IQR]) initial and final EMS SBP values decreased from 198 mmHg (180–218) to 168 (148–187), respectively. The median (IQR) pulse decreased from 108 (92–125) to 103 (86–119), and the median oxygen saturation increased from 89% (82–95) to 98% (96–99). Three episodes (1.3%) of asymptomatic hypotension occurred, and none required intervention.ConclusionThis study supports a favorable safety profile for prehospital bolus‐dose intravenous nitroglycerin for decompensated CHF with APE. Blood pressure, heart rate, and oxygen saturation improvements are also demonstrated. Further, prospective studies are needed to confirm these findings.

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Adverse events after prehospital nitroglycerin administration in a nationwide registry analysis

Cited by 4 publications

References 24 publications

Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

A Systematic Literature Review of Hispanic Adults’ Experiences With the Emergency Medical Services System in the United States Between 2000 and 2021

Safety of prehospital intravenous bolus dose nitroglycerin in patients with acute pulmonary edema: A 4‐year review

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