Tag Archives: nitro

Dynamite

15 Sep

During the 1860s workers at Alfred Nobels dynamite factory who suffered from heart conditions noticed that (opposite to most of us) their chest pains eased once they once they came to work. It was eventually discovered that nitroglycerin dilates the blood vessels, which provided relief from clogged arteries.

From: the complete idiots guide to Fun Faqs.

Nitro is cool.

Advertisements

No more nitro for you

2 Jun

nitroDear Patient,

You have been in PCU for 2 weeks. You have had a 2dECHO, an ECG every day, continuous rhythm strip monitoring, blood pressure  checks every 4 hours times 24 hours for the past 2 weeks. You are on 3 liters of oxygen at home and in the hospital even though I checked you on room air your saturation was 96%. You have had a CT of the head, chest, abdomen and pelvis: all negative. You have had ultrasounds of all four extremities all negative for blood clots. You move your bowels everyday. Your urine output is adequate. Your lungs are clear. Your heart sounds S1 and S2 with the absence of S3, no murmers, rubs, or clicks. There is no neck vein distention and no edema anywhere (fat tissue is not edema).  You have positive pedal pulses palpable even after your heart catheterization which revealed nice clean coronaries.  You have upper GI series with small bowel follow through: normal. Of course you had an EGD and a colonoscopy: normal.

I have six patients of which you are one, although that is not really your problem. It is my problem, considering, one patient in end-stage  heart failure, one is in respiratory distress on and off the biPAP, one is confused and keeps ripping out IVs and bleeding all over the place and one is probably septic.

So I am sorry that I refuse to give you sublingual nitro anymore that keeps me in the room for lengthy periods of time reassessing your pain, your blood pressure and another stat ECG. Especially since you then turn around and eat a huge lunch that consists of a saltless hospital food burger and fries. And I realized after 3 consecutive shifts with you that it does not matter if I give you nitro, maalox, tylenol, or any other PRN medication that you have on board: they all work the same for you. It is the placebo effect of getting something that takes away your pain so I refuse to keep slipping that small little sublingual pill called nitro under your tongue!

The Maalox  and Xanex work just as good lonely patient: I am sorry I can not just hang out with you all day, because you never seem to have chest pain when I am in your room listening to you complain about how you just do not know what is wrong with you.

And even though you did not mind the huge work up that you just went through last admission (one month ago) that was all repeated this admission:  I am sorry that you have an internal medicine doctor and a zillion specialty consults that can not figure out your real problem. I get this feeling you do not want to go home for some reason: and I feel sad for you.  If you could just tell me what is going on maybe with the help of the social worker we can find out why you want to stay here. All this invasive expensive testing is a hazard to your health.

Love,

Your Nurse

Disclaimer: I am a firm believer in the fact that lengthy stays in the hospital with no identify-able acute illness is hazardous to ones health.  I am not burned out from patient care. I love my job. I do find irritation from time to time when I am super busy with acutely ill patients that need/demand my presence and prescribed interventions and feel overwhelmed by patients that need/demand emotional support but are otherwise healthy and figured out the best way to get the nurse in the room is to put on the call bell and express chest pain 10 out of 10: even as you enter the room and find: the patient in no distress, not short of breath, skin warm and dry: cardiac markers negative time 30 sets, no ecg changes and a totally benign assessment. So you do the whole chest pain work up routine again and it sucks up all your time and inside you find yourself angsty worrying about your other sick patients. And this repeats every 2 hours. I would love to be able to provide emotional support but unfortunately: airway breathing and circulation on my other sick patients left me with little time for this particular situation.