Which statement correctly describes nitroglycerin administration in the EMS setting?

• A. It is generally given when SBP is 100 or higher and there is ischemic chest pain
• B. It is given to all chest pain patients
• C. It is given after meals
• D. It causes hypoglycemia

Answer: (A)

Nitroglycerin helps treat ischemic chest pain by dilating veins (and to a lesser extent arteries), which reduces preload and myocardial oxygen demand. In the EMS setting, it is given only when the patient has chest pain suggestive of ischemia and there is enough blood pressure to tolerate the drop that nitro can cause. A systolic blood pressure of 100 mmHg or higher provides a safety margin so that the fall in pressure does not compromise perfusion. This safety threshold is the reason this statement is the best fit: it reflects the primary precaution in real-world use.

It isn’t given to every chest pain patient—BP must be assessed and contraindications considered, such as hypotension, suspected right ventricular infarction, or recent use of phosphodiesterase inhibitors (like sildenafil). The fact that it isn’t administered after meals isn’t a factor in EMS practice, and nitroglycerin does not cause hypoglycemia; its main concerns are headaches, dizziness, and possible hypotension rather than blood sugar effects.