Physicians in the emergency room setting see thousands of patients a year that come in with angina (chest pain),  Nitroglycerin is one of the first drugs that is given to help relieve the discomfort.  Nitroglycerin sub-lingual is mentioned in the ACLS course during the Acute Coronary Syndrome algorithm.  Family members should be educated to never drive a person to the ER when they are experiencing chest pain.

There are several reasons a family member should NEVER drive someone to the ER with chest pain.  ACLS course instructors and other medical professionals can attest to the following scenario:
A husband had dinner and asked his wife to take him to the hospital because he was having chest discomfort, making it hard to breathe and had lots of pressure in the middle of his chest.  While en route to the hospital the husband collapses, although he is only 5 minutes away, time is of the essence.  At this point there is no way to provide oxygenation to the husband, no medication is available to be given to thin the blood to help blood flow easier.  The ACLS course does not encourage this type of decision making.

Upon arrival to the hospital the patient remains unresponsive.  No neural-muscular function noted.  Sinus Rhythm with PVC’s.  There will eventually need to make a decision when to take this person off of life support.  The ACLS course is required for any professionally licensed personnel to become certified, especially if they give direct care to adult patients.  The certification is valid for 2 years.

Nitroglycerin sub-lingual (under the tongue) should be given at the first sign of chest discomfort, and then every 5 minutes for a total dose of 3.  If after the 3rd dose you do not have any relief, it is crucial to call for 911.  The reason is:  usually after the 3rd dose if the vessels have not relaxed the vessels enough for blood to flow through easily, then there is almost 100% chance it is not effective.  The paramedics that come out have to have an ACLS course in order to provide emergency treatment to people.

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