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First up is our Quick Hits EBM specialist, Justin Morgensern, who's going to talk about nitroglycerin in Scape. So that's IV-nitro-dosing in sympathetic crashing acute pulmonary edema,

the six CHF patient with lots of blood pressure to work with.

The report from EMS was the patient was fine an hour ago. Now they look like

they're going to die. Sats in the 70s, blood pressure above 200, drowning in pulmonary edema

crackles everywhere working very hard to breathe. This is sympathetic, crashing, pulmonary edema

or escape. And the question is, are you using the right

dose of nitroglycerin? Because I think most people probably aren't. Most people in medicine

have probably been underdosing nitroglycerin. In residency, I was taught, you know, you start a

nitro grip at something like 10 or maybe 20 mics a minute, 50 was considered very high dose.

Now, since I was in residency practice has changed somewhat and I've seen people using higher

and maybe appropriately dosed nitroglycerin. There's been a few observational studies suggesting

safety at higher doses and personally I have safety at higher doses, and personally,

I have been using higher doses, but this year we had our first RCT.

It's an open label, single center RCT.

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