High-dose NTG boluses

High-dose nitroglycerin boluses may prevent endotracheal intubation and ICU admission in patients with acute hypertensive heart failure.

Protocols of dose recommendation:
1. Inclusion: SBP > or = 160 mmHg or MAP > or = 120 mm Hg, who failed to response to initial O2, sublingual NTG x 3, and furosemide.
2. Dosage: 2mg of NTG IV boluses slowly in increments q3-5min, up to a total of 10 doses.

Contraindications of NTG in lung edema or AHF:
1. Severe aortic stenosis (AS).
2. HOCM or LVOT obstruction with SAM (systolic anterior motion of the mitral valve).
3. Recent use of Viagra or Cialis.

Reference:
http://www.ajemjournal.com/article/S0735-6757(16)30734-3/abstract
http://www.ncbi.nlm.nih.gov/pubmed/17509731
http://emdxhouse.com/2016/01/07/
http://emcrit.org/podcasts/scape/

http://twitter.com/srrezaie/status/840034055559229441

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http://www.ajemjournal.com/article/S0735-6757(16)30734-3/pdf