Hi Dr. Strong, current M4 here. This content is exactly what i have been looking for as a soon to be intern! A lot of UpToDate and journal articles throw too many details while not highlighting the most important points. I, and I'm sure my future patients, will be so appreciative of this education.
Hi Dr. Strong, I am an ICU RN currently in my clinical rotations at Stanford to complete my acute care nurse practitioner program. I came across your channel, and it's been beneficial and very interesting. I've been binge-watching your videos; your channel is phenomenal. Thank you so much for sharing your knowledge, and it is my hope I run into you and meet you one day! Thanks again!
Thank you for the kind words, and I'm very glad the channel has been helpful! I hope your rotations at Stanford have been going well. I'm not in the hospital this week, but will be back from Saturday onward - please say hi if we run into each other!
One might consider double checking the drug history, to be sure that no-one gave the wrong drug to the wrong patient at the wrong dose at the wrong time. Or maybe a friend or relative was trying to help by slipping a patient a drug or remedy or medicine to "help".
Yes - excellent point! At a previous hospital, I once had a patient be accidentally given IV diazepam (Valium) instead of the ordered IV diltiazem. She was in the CT scanner before we realized what had actually happened. Luckily she was ok, but that generated quite the safety review!
It's my impression that the most referred to paper on this question is here: pubmed.ncbi.nlm.nih.gov/14678917/ This study looked at 459 consecutive patients who were admitted through an ER for chest pain *and* had received nitroglycerin. Relief of pain was defined as a >=50% reduction in pain within 5 minutes of receiving nitro. Among those patients whose pain was believed to be due to "active coronary ischemia", nitro relieved the pain in 35%. Among patients whose pain was believed to be due to another etiology, nitro relieved pain in 40%. The difference in this study was not statistically significant, so in retrospect, it would have been more accurate for me to have said that relief with NTG has no impact on the probability of ACS. (Sorry, all of the relevant studies look to be behind paywalls.)
