Blood pressure and rate control
Nitroglycerin (Tridil) drip
NTG, Tridil
Dosing
| Start | 5–10 mcg/min. Flash pulmonary edema with SBP 160 or more (SCAPE): high dose, starting at 100 mcg/min with NIV (CAEP 2025) |
|---|---|
| Titrate | 5–10 mcg/min every 3–5 minutes; larger steps above 20. SCAPE: toward 200 within minutes, then wean as BP and breathing settle |
| Maximum | 200 mcg/min (some protocols and SCAPE 400) |
| Common bags | 50 mg in 250 mL (200 mcg/mL); 25 mg in 250 mL (100 mcg/mL); 100 mg in 250 mL (400 mcg/mL) |
| Dose units | mcg/min |
Line and administration
- Glass bottle and non-PVC tubing: PVC absorbs nitroglycerin
Watch for
- Hypotension and headache
- No PDE-5 inhibitor in the past 24–48 hours
- Avoid in RV infarction
- Tolerance after about 24 hours
Nitroglycerin: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- ACS and STEMIInitial medications: Typical adult doses for exam study; follow your institution's or agency's protocols. EMTs: aspirin and assisting with the patient's own nitroglycerin.
- Aortic Dissection and Hypertensive EmergencyIV antihypertensives: Nitroglycerin: 5–200 mcg/min: Best for ACS and pulmonary edema; headache
- Heart FailureDecompensated HF and shock: Warm-wet: Most common: IV loop diuretic; vasodilator (nitroglycerin, nitroprusside) if BP allows
- Vasopressors and InotropesLines, extravasation and titration: Extravasation: stop the infusion, aspirate, remove the catheter, mark and elevate. For catecholamines or phenylephrine, infiltrate phentolamine 5–10 mg in 10–15 mL saline subcutaneously as soon as possible (label: within 12 h). Alternatives: terbutaline or topical nitroglycerin.
- After Cardiac SurgeryHemodynamics, low output and vasoplegia: Afterload: hypertension strains suture lines and raises bleeding; use nicardipine, clevidipine or nitroprusside, or nitroglycerin when ischemia or radial spasm is the worry. After mitral repair for regurgitation the LV loses its low-pressure outlet into the atrium and tolerates afterload poorly.
- ED Triage and ESIDecision point A: lifesaving intervention now: Medications: Naloxone, dextrose, epinephrine, atropine, adenosine, dopamine: Aspirin, IV nitroglycerin, antibiotics, heparin, analgesics
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Other blood pressure and rate control
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.