"Preparation to treat angina" ?

[prv]

The first aid kit on Kindred Spirit was more or less useless - you could have done just as well with gaffer or electrical tape, kitchen paper, and teatowels. I've decided to put a more comprehensive first aid and medical kit on Ariam, and as a basis I bought an MCA Cat C kit. Note that this isn't a coded charter boat, it just seemed like a useful set to start off with.

One item in the kit is a "glyceryl trinitrate" (which apparently is a less-alarming synonym for nitroglycerine) spray, listed as being for treatment of angina. All well and good, seems like a useful thing to have, but how exactly is it supposed to be used?

I believe the symptoms of a heart attack are chest pain, shortness of breath, and pain down the left arm. But is angina the same thing as a heart attack? And if someone's having one, do you rush in with the spray as soon as you realise what's going on, or is there time to wait, have a think, call the coastguard for a link to a doctor (which is not a fast process, I've overheard it being set up before)? I guess it's telling that this is the one medicine (apart from iboprofen, paracetamol and Immodium) that the MCA think a boat needs to have even if it's relatively near the coast. Having done a couple of landbased first aid courses some time ago, I'm probably rusty but have at least some knowledge of CPR, stopping bleeding, etc - but this little bottle is a complete mystery, and I don't like mysteries on my boat.

I suppose some people will tell me it's just a quirk of MCA bureaucracy and as a non-coded boat I should just ignore it - but if it's in the kit I want to know how to use it.

Cheers,

Pete

 

[thalassa]

Well, I can't claim to be an M.D, but I can tell you that it worth having on the boat. I suffered a heart attack while sailing, and in hindsight, it could have probably prevented the 20 % loss in heart muscle power that I now have. Using it is straightforward: just spray it under the tongue. It's also available as a tablet - also used under the tongue. AFAIK it is useless for prevention -there is aspirin for that- but it acts surprisingly quickly, widening the arteries of the heart and keeping the oxygen level high enough. I believe Angina is the name of the disease of having narrowed arteries, resulting in breathlessness and sudden 'power failures'. These are the warning signs. In a heart attack, the oxygen resulting from a partial or fully blocked is so low that the heart muscle goes in a cramped state, eventually stopping altogether. Not good. Basically, the spray is a nitrate product, limiting permanent damage to the heart muscle by helping the supply of oxygen.

 

[KAL]

Hi Pete,

It goes in the mouth, under the tongue, usually. Is it called Nitrolingual?

If someone's got angina the symptoms are similar to those of a heart attack ("vice-like" pain in the chest, spreading to jaw and one/both arms, breathlessness, anxiety, etc.) but the pain symptoms ease when they rest, which they don't tend to with a heart attack.

Most angina sufferers will carry their own TNG/GTN/Nitrolingual.

 

[Uricanejack]

Its not something I would plan on putting in a first aid kit. I would never give it to someone without medical advice.
unless I had angina or one of my crew or guests had angina in which case i would expect them to bring there own and know what to do with it.

If you have a copy of the Ship Capts Medical Guide and international code of signals they cane be used together to get medical advice even with a launguage barier.
Unfortunatly you need to be able to talk to a shore station which are becomig hard to find or a ship with a doctor.

 

[mikemanor]

If you do the one day RYA First Aid Course, this includes the contents of a Cat-C first Aid Kit. You should be shown what is in the kit and how to use it. You will also get an update on the current CPR protocol.

Cue for links to internet CPR clips

 

[KAL]

If you do the one day RYA First Aid Course, this includes the contents of a Cat-C first Aid Kit. You should be shown what is in the kit and how to use it. You will also get an update on the current CPR protocol.

Cue for links to internet CPR clips

+1. Well worth it too.

 

[prv]

Unfortunatly you need to be able to talk to a shore station which are becomig hard to find

No Coast Radio Stations in the UK, and rare in the rest of Europe, but for emergency medical advice the Coastguard can do a phone patch to a doctor. It's basically just a phone call to A&E though, so it may take them a few minutes to find a spare doctor and get him or her to the phone.

Pete

 

[maxi77]

Having had a heart attack and had minor replumbing, (stent) I never go anywhere without my little bottle of gtn which was the only medication I was allowed without asking for it whilst in hospital. Angina is a general term for chest pain, the cause usually is heart problems. The sufferer sprays it under the tongue and it improves the blood flow around the heart.

 

[Scomber]

If you do the one day RYA First Aid Course, this includes the contents of a Cat-C first Aid Kit. You should be shown what is in the kit and how to use it. You will also get an update on the current CPR protocol.

Cue for links to internet CPR clips

yup-just did it 2 wks ago and update on cpr and how to use portable defibrillators -very useful info (not that you'd have one on board !) -good for general everyday confidence-

 

[Sniper]

Everything said above regarding GTN is correct. Just be aware, however, that it doesn't just widen the coronary arteries (and may not actually do that, given arterial stenosis) - it widens all of the body's vasculature. This has the effect of lowering blood pressure which in turn reduces the preload on the heart, in turn reducing oxygen requirements and thus myocardial hypoxia. The net effect is reduced pain. However, a side-effect of lowered blood pressure can be fainting, so if you take it and feel faint, don't misunderstand the symptoms and take more GTN!

For those gentlemen of a certain age, there is a potentially fatal interaction between sildenafil (Viagra) and nitrates; do not mix the two within 24 hours.

 

[johnalison]

For those gentlemen of a certain age, there is a potentially fatal interaction between sildenafil (Viagra) and nitrates; do not mix the two within 24 hours.

Other than this, GTN is pretty safe in general use and it will seldom be wrong to give it, even if the diagnosis is wrong.

Being a highly reactive compound, the shelf life of the tablets is short but the spray is longer, but worth checking the use-by date.

 

[prv]

Other than this, GTN is pretty safe in general use and it will seldom be wrong to give it, even if the diagnosis is wrong.

That's good to know.

Being a highly reactive compound, the shelf life of the tablets is short but the spray is longer, but worth checking the use-by date.

The kit as a whole had an expiry date in 2015, so the spray can't be duff before then. Good point in general though. Google suggests that tablets are only good for eight weeks!

Pete

 

[Champagne Murphy]

Everything said above regarding GTN is correct. Just be aware, however, that it doesn't just widen the coronary arteries (and may not actually do that, given arterial stenosis) - it widens all of the body's vasculature. This has the effect of lowering blood pressure which in turn reduces the preload on the heart, in turn reducing oxygen requirements and thus myocardial hypoxia. The net effect is reduced pain. However, a side-effect of lowered blood pressure can be fainting, so if you take it and feel faint, don't misunderstand the symptoms and take more GTN!

For those gentlemen of a certain age, there is a potentially fatal interaction between sildenafil (Viagra) and nitrates; do not mix the two within 24 hours.

And a blinding headache (which is still better than an MI) Its short lived though (the headache that is)

 

[ratbag]

i think you will find that gtn spray will need a prescription , not sure about uk but definitly in ireland
a bit dodgy administering it without knowledge of persons history, if theyre chest pain is caused by low blood pressure
gtn will most likely kill them
that said having a spray on board would make sense if you have a crewmate who is prescribed it & might not have it with them.

 

[Ru88ell]

I had some very strange looks for having tampons in my mountaineering FAK when I was in my twenties. They were needed twice by DoE Gold candidates who came unprepared.

I use GTN, and I'd be very grateful for some if I really needed it and had forgotten my own.

 

[prv]

i think you will find that gtn spray will need a prescription , not sure about uk but definitly in ireland

Not if bought as part of an MCA first aid kit, apparently. The spray bottle is on my dining room table at this moment, no prescription involved. Same as the kit comes with 50 ibuprofen tablets and 64 paracetamol, which is more than you can buy off the shelf in one go (a somewhat pointless anti-overdose measure).

Pete

 

[alan_d]

Same as the kit comes with 50 ibuprofen tablets and 64 paracetamol, which is more than you can buy off the shelf in one go (a somewhat pointless anti-overdose measure).

Pete

Are you suggesting that reducing self-poisoning is pointless, or that smaller pack sizes of analgesics are ineffective in doing so?

There is good evidence to suggest that reducing pack sizes of paracetamol saves lives; see http://www.bmj.com/content/346/bmj.f403

 

[PilotWolf]

The usual biggest clue between an AMI (heart attack) and angina is that angina pain will ease with rest and the patient usually knows that they have angina.

Whilst relatively 'safe' GTN should NOT be just given (like any drug) as there are risks to using it. It is a vasodilator and if you have acutely low blood pressure (from unseen bleeding for example) it could reduce your blood pressure to a dangerous level. The other high risk is above - I had a patient years ago who had taken viagra and then GTN, I don't recall if he survived but he was seriously ill and fighting for his life when we left him in A&E.

The tablets are useless a couple of weeks (IIRC) after opening the bottle.

W.

 

[prv]

Are you suggesting that reducing self-poisoning is pointless, or that smaller pack sizes of analgesics are ineffective in doing so?

I was suggesting that smaller packs inconvenience those who just want to stock up the bathroom cabinet, and probably cost more per pill than the old bottles of 50 or 100 (or whatever it was) Nurofen, but (I assumed) wouldn't do much to dissuade someone intent on killing themselves as they could simply visit several shops one after the other (or even several checkouts at the same big supermarket).

Perhaps people are less good at topping themselves than I give them credit for.

Pete

 

[alan_d]

I was suggesting that smaller packs inconvenience those who just want to stock up the bathroom cabinet, and probably cost more per pill than the old bottles of 50 or 100 (or whatever it was) Nurofen, but (I assumed) wouldn't do much to dissuade someone intent on killing themselves as they could simply visit several shops one after the other (or even several checkouts at the same big supermarket).

Perhaps people are less good at topping themselves than I give them credit for.

Pete

I agree that small pack sizes are inconvenient, and I tend to subvert the restrictions myself by stocking up when I am in the US. (After all, why stop people buying 500 paracetamol tablets when they have a constitutional right to a gun?)

There is, however, robust evidence to show that reducing access to any means of suicide reduces the overall number of suicides, so things like small pack sizes and high fences at favoured jumping spots do make a difference, counterintuitive though it seems.