Do you carry aspirin?

Do you carry aspirin in case of heart attack?

Teacher

No, but I take a Baby Aspirin (87mg) daily.

Unless you are an M.D. you SHOULD NOT give asprin to a suspected heart attack victim.

Get them to lie down. Elevate their limbs. Keep them calm. Call 911.

The reason thay you DO NOT give it is that it is very difficult for untrained individuals to differentiate between a heart attack victim and someone who is suffering a stroke.

If it is a stroke you will kill them.

Leigh. Do you have a reference for that?

Leigh,
I EDC asprin and as an EMT I can give it to any patient,(with medical control clearance) my Cardiologist says it's a good way to help if you're having chest pains "WARNING" if you are allergic to asprin "DO NOT TAKE"

Mike

A stroke is basically the same thing as a heart-attack, just in different places. Giving aspirin to someone with a stroke won'kill him. Maybe you mean a aneurysm or internal bleeding?

I personally carry Acethaminophen, Ibuprofen and Asperin. This gives you some options in case someone is allergic, has GI-complains, etc.

I just recently bought one of those pill vials at Wally World and put the Bayer Aspirin's in it that they make just for that purpose, it's attached to my EDC

I carry asprin for that reason...just a couple of pills just in case.

Don't confuse headaches and heart attacks. Acethaminophen/Tylenol is great for a simple headache, but the reason Aspirin is used in suspected heart attacks is for its anti-platelet (blood-thinning) properties. AFAIK Acetaminophen and Ibuprofen do not have anti-platelet properties.

Be careful when using Acetaminophen, the side-effects can be extremely harmful to your liver.

I carry Aspirin and Ibuprophen/Motrin.

I'm not a doctor and don't play one on the web, so don't take the above as medical advice, talk a real doctor.

There are main types of strokes. An ischemic stroke is caused by a blood clot in the brain, and is the type that is similar to a heart attack. A hemorrhagic stroke, on the other hand, is caused by a ruptured blood vessel in the brain.

If it is a blood clot (ischemic) stroke, Aspirin will help the victim. If it is a ruptured blood vessel (hemorrhagic) stroke, Aspirin will make matters worse.

Citation: American Heart Association: Aspirin in Heart Attack and Stroke Prevention

So what should we do if we're out hiking and have a heart attack / Stroke and there is no cell phone reception and no chance of getting help anytime soon ???

i would hope that it is not yet my time to go. but if it was, then i'd try to realize what a great setting i was in and go peacefully. for me, better in the woods doing something i like rather than in a hospital with death being prolonged.

if not your time yet, rest up, try to weather the immediate storm, and when possible get out. exercise will increase the damage.

after working in ers for many years it became apparent to me that when your time was up, your time was up.

i saw people who never should have died - young and/or good health otherwise, found immediately, cpr / first aid begun instantly, excellent pre-hospital care, finest mds and nurses, patient died. i saw others who should have died - all that could possibly be wrong with the above scenario, was - and who survived. go figure.


bsmith

I'm not sure I could even identify somebody having a heart attack vs some other critical condition.

I couldn't have said it better. I'd rather be found later by the next hiker down the trail than end up in a convalescent center waiting for my turn.

Better yet. . . I've noticed a trend that when people who are in very good physical condition (read athletes) have a heart attack, it's usually catastrophic and they are DRT. Folks who are out of shape have a slower heart attack and they have time to take aspirin and call an EMT. Anybody else notice this or am I seeing a trend that's not real? I'd rather go with the first group; ie., doing something active that I enjoy one moment and BOOM -- game over, DRT.

As a practicing Cardiologist I deal with this daily. Aspirin (if not given before arrival) is one of the first things given to chest pain patients upon arrival to the ER. It should not routinely be given to someone suspected of having a stroke without further testing first. Both heart attacks and stroke may present with atypical or confusing symptoms, BUT rarely (never?) are they confused with each other.

Heart attack an Stroke Warning Signs:
http://www.americanheart.org/presenter.jhtml?identifier=3053


Additional statements from the American College of Cardiology re: aspirin use with heart attacks:

http://www.acc.org/qualityandscience/clinical/pdfs/UA_NSTEMI_Final_pocketpullout.pdf

http://www.acc.org/qualityandscience/clinical/guidelines/stemi/index_pkt.pdf page 14


The American Heart Assoc. site has additional comments on the effects of NSAIDS (Tylenol, Motrin, etc.)
As it relates to heart attacks (use the search function)


Discussion at the Wilderness Medicine meetings relative to “wilderness cardiology” usually revolve around the use of aspirin and possibly beta-blockers. In “wilderness” (or “survival”) situations your resources for emergent cardiac care are usually pretty limited. Urgent evacuation (if possible) is usually you best option.

Marduk & JCWohlschlag

Thanks for those links, great information.

Acethaminophen is by far the safest of the bunch. There's a risk of liver-damage, but that's only after a long period and a high concentration of the stuff.

If you put it in contrast, the chances of getting stomach-problems with Ibuprofen are far greater than the chance of liver-problems with Acethaminophen..

I just started carrying half/dose aspirin per my doctor's recommendation and to take one daily. But I carried it anyway in my FAK.

As I recall, I've never been prescribed Tylenol, but I have been prescribed Motrin (in the 800 mg form) on more than one occasion as an anti-inflammatory. For me, aspirin works just fine for minor headaches (with the dual use of being available for heart attacks) although I probably should add Tylenol to the kit for others who are aspirin intolerant.

That said, when the side effect of one drug is an ulcer and the side effect of another is death, I'll risk getting an ulcer. YMMV

Yup. I take one every morning, along with a handful of prescription meds and some vitamins, and carry more along, in case of the big one. Or a simple headache. Then do not bother my stomach at all, nor do the 800mg motrin I take on a pretty regular basis for my bum back. A co-worker got chest pains at the office one night, his partner had him pop an aspirin then ran him over to the hospital...minor heartattack, no damage, thanks, according to the dr, to the aspirin...

Leigh,

As others have pointed out this is incorrect advice. I am not sure what signs and symptoms you are talking about but heart attacks and strokes very rarely mimic each other. You were right about getting a patient to calm down and call 911, but your advice strays from the accurate from there.

So what are the (short list) signs and symptoms of a Heart Attack (AMI: Acute myocardial infarction) and Stroke (CVA: Cerebrovascular Accident)?

AMI

• Pain in chest, back (between should blades)may be described as a heaviness or squeezing but absence of these descriptive phrase should not be used as a "rule-out".
• Shortness of breath
• Sweating
• "Indigestion" or Nausea

CVA

• Alterered Level of Consciousness
• Impaired motor function (may be one sided)
• Difficulty speaking or loss of speech
• Headache (often described as the worse ever experienced by the patient, which can be a major indicator that it is a Hemorrhagic vs. Ischemic CVA)

These are both short lists, but get the point across.

Aspirin is considered one of the second-line medications in an patient experience "Pain of a probably cardiac origin", with Oxygen being the first-line medication and Nitroglycerin and Morphine following the administration of Aspirin. Note the vagueness of the term "Pain of a probably cardiac origin". It is specifically vague because we are treating a SYMPTOM prior to the diagnosis, and it is the treatment of choice for this symptom as recommended by the American Heart Association (specifically 162 to 324mg or 2-4 baby aspirin chewed). I am not even going to look at a ECG (and either are most other ACLS providers including MD) to help determine if I should administer Aspirin; your having Chest Pain or similar pain... your not allergic to Aspirin... your are able to chew and swallow on your own... you are getting the Aspirin.

Aspirin alone won't stop a heart attack, but repeated research has shown that early administration of Aspirin after the onset of sign and symptoms of a heart attack can greatly improve the eventual outcome. Calling 911 as soon as possible should be your primary priority.

I don't know if I would go so far as to classify ANY of those three medications as "safer". All have their dangers and their beneficial uses. Each medication has been proven to not only be safe but effective if used as directed and intended.

FWIW, I have seen more patients with long-term health issues due to Acetaminophen abuse (intentional and accidental) then either of the other two mentioned mediations. Doesn't make it unsafe, just a warning to follow the direction and MD's orders... more is not always better.

An extremely good point. Even so called 'herbal' or 'home remedies' can be harmful if not used properly. And meds which are 'safe' might not be depending on the patient or the combination which they are taken with other medication.

I once took some ColdFX and some back pain meds which had a high dose of asprin. I later had a bloody nose which wouldn't stop. I'm prone to bloody noses but in my thirty years I'd never had one where the blood came out thin like water.

I later did the homework and learned that asprin thins the blood...and that ColdFX is full of ultra concentrated Ginseng...another blood thinner.

There is a bison capsule with 325mg Bayer on my vehicle keys.

While all NSAIDs (acetaminophen, ibuprofen, naproxen, etc.) all have legitimate uses, they all also have the potential for significant side effects. The longer you take them, the higher the dose, the more likely you are to have side effects. As it is relevant to this thread, ONLY ASPIRIN has any utility in reducing the effects of a heart attack.

In regards to reduction of mortality (reduce the chance of dieing), only aspirin and beta-blockers have been shown to be effective. O2, NTG, and morphine relieve symptoms but don’t reduce mortality. From a practical standpoint only ambulances would have prehospital access to O2 and morphine.

"...only ambulances would have prehospital access to O2..."

We carry O2 with us, "just in case." Got the regulator (the most expensive part) and a couple of empty bottles at a yard sale (after the death of an old person), went to a med supply store and swapped the empties for full bottles for a reasonable price. Nasal canulas are readily available and cheap. You can probably get your family doctor to write a prescription for O2 if you ask. Cheap insurance...

I think the critique has been beat enough.

There is a type of stroke which could be made much worse by aspirin, a hemorrhagic stroke. Otherwise known as bleeding into the brain.

But, as so well pointed out, for people with even a smattering of diagnostic skill a stroke and heart attack are not all that easy to mistake for one another.

That said Leigh_Ratcliffe makes a good point about not assuming too much or jumping in too soon. Keeping the person calm and calling 911 is not bad advice. Most city and suburb dwellers are so close to 911 advice and EMT/rescue services that waiting until your advised to give aspirin or for the troops to arrive isn't much of a risk.

There is certainly still some risk of an unknown allergy or unexpected interaction. Some number of people likely to have a heart attack are already on aspirin and/or other blood thinners that could make them very prone to bleeding. So stuffing aspirin into people you happen to think are having a heart attack isn't something you want to do casually. Every therapy and drug has side effects. Don't go off half-cocked.

In more remote locations, or when emergency services are overwhelmed or unavailable, your much more on your own. Assuming 911 still works and realizing that EMTs are not on the way they may advise you to administer aspirin.

I don't carry aspirin on me but all of my first-aid kits have some aspirin in them. Even the tiniest one has a couple of single-dose foil packets in them.

Aspirin is good stuff. Good for fevers (But not for kids because of Rye syndrome), headaches and moderate pain. Also not for a person with serious bleeding, internally (As is possible after an auto accident or hemorrhagic stroke) or the much more obvious external bleeding.

Generally Tylenol is safer and less likely to interact with other drugs but it is much more toxic to the liver than other OTC pair relievers. So don't take Tylenol for a hangover or when the person is jaundiced or shows signs of their liver being under stress. But Tylenol is good. It will take the edge off of a lot of pain.

Generally Ibuprofen is my go-to pain relief for joint or bone pain. It seems to work better for this than Tylenol.

I think the critique has been beat enough.

There is a type of stroke which could be made much worse by aspirin, a hemorrhagic stroke. Otherwise known as bleeding into the brain.

But, as so well pointed out, for people with even a smattering of diagnostic skill a stroke and heart attack are not all that easy to mistake for one another.

That said Leigh_Ratcliffe makes a good point about not assuming too much or jumping in too soon. Keeping the person calm and calling 911 is not bad advice. Most city and suburb dwellers are so close to 911 advice and EMT/rescue services that waiting until your advised to give aspirin or for the troops to arrive isn't much of a risk.

There is certainly still some risk of an unknown allergy or unexpected interaction. Some number of people likely to have a heart attack are already on aspirin and/or other blood thinners that could make them very prone to bleeding. So stuffing aspirin into people you happen to think are having a heart attack isn't something you want to do casually. Every therapy and drug has side effects. Don't go off half-cocked.

In more remote locations, or when emergency services are overwhelmed or unavailable, your much more on your own. Assuming 911 still works an

In regards to reduction of mortality MUCH more then ASA and beta blockers have been shown to be effective. Nitro and Morphine along with Aspirin and Oxygen has been shown to improve short term mortality and while not the definitive care for a MI they are the like aggressive bleeding control in a GSW patient... they will get you to the definitive care.

I don't know where you level of knowledge, training or experience is but your post reads as a paraphrasal or Wikipedia



Another good point and one I meant to make but missed. What medications we carry as laypersons should (in most cases) be kept for use on us and or families. Someone asks you for an Aspirin, fine but otherwise keep you treatments (and giving someone a drug or any kind, OTC or otherwise is a treatment) to within you scope of practice.

Follows is an excerpt from this site. http://www.health.harvard.edu/fhg/updates/update0505a.shtml

"Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence."

"To find out how aspirin works fastest, researchers in Texas asked 12 volunteers to take a standard 325-mg dose of aspirin in three different ways: by swallowing a tablet with 4 ounces of water, by chewing the tablet for 30 seconds before swallowing it, or by drinking 4 ounces of water with Alka-Seltzer. Each subject tried all three methods on an empty stomach on different days. The scientists monitored blood levels of aspirin and its active ingredient, salicylate, at frequent intervals, and they also measured thromboxane B2 (TxB2), an indicator of platelet activation that drops as platelets are inhibited."

"By all three measurements, chewed aspirin worked fastest. It needed only five minutes to reduce TxB2 concentrations by 50%; the Alka-Seltzer took almost 8 minutes, and the swallowed tablet took 12 minutes. Similarly, it took 14 minutes for the chewed tablet to produce maximal platelet inhibition; it took Alka-Seltzer 16 minutes and the swallowed tablet 26 minutes (see graph below)."

...and Call a Ride
Walk-in patients wait almost twice as long in the E.R. as those who arrive by ambulance, according to a University of New Mexico study.

Besides the wait in the ED... you have the whole ride to the hospital where treatment could already have begun.

Alan:
I was one of first paramedics in MO 30 years ago, then worked as an ER and ICU RN. I am currently a board certified Internist and Cardiologist. I also spent short stints as a Deputy Sheriff and Firefighter. I treat MIs on a nearly daily basis.

I was trying to provide a limited response to a question. Historically the impact of NTG, and to a lesser extent O2, has been dramatically lessened with improving therapy. That doesn’t mean they have no place in treatment, but that priorities have changed. Often in the throes of an MI patients are hemodynamically unstable. If I have a limited amount of BP “to work with”, I would rather use it up by giving beta-blockers rather than NTG. More “bang for the buck” so to speak.

Current therapy for MI is complex and fluid.
I would refer you to the American College of Cardiology site for detailed treatment recommendations and rationale: http://www.acc.org/qualityandscience/clinical/topic/topic.htm . Look to these sections relative to this discussion:

ST-Elevation Myocardial Infarction: ACC/AHA Guidelines for the management of Patients With

Unstable Angina/Non-ST-Elevation Myocardial Infarction: ACC/AHA 2007 Guidelines for the Management of Patients With

Edit:
At the risk of beating a dead horse. Additional info on MI treatment priorities:

http://www.acc.org/qualityandscience/clinical/measures/stemi/pdfs/STEMIfinal.pdf
http://www.acc.org/qualityandscience/clinical/measures/stemi/pdfs/EditorialFinal.pdf


http://www.acc.org/qualityandscience/cli...isory040105.pdf
http://www.acc.org/qualityandscience/clinical/practice_advisory/pdfs/COMMITBetaBlockerFACTSheet.pdf

Alan,
With respect: You are a trained individual. Most people on this forum are not. Giving asprin assumes various things like the victim being coherent. If help is hours or days away then giving asprin becomes a case of administer it and pray, against not administering it and watching them die.

One other point and at the risk of offending everyone, administering a drug, if you are not a MD or ERT makes you liable in law for the consiquences.

Hmmm. . . since I can't force someone to take aspirin and can't chew it for them, what if I make a couple aspirin tablets available to an apparent heart attack victim; am I liable for the consequences if he dies?

Stroke and MI are in two different part of the bodies... MI or heart attack is manifested by chest pain while stroke by headache, one sided weakness, slurred speech and facial droop. Not much to mix up there. You may never know if your chest pain guy ever had a real deal MI or was it just angina (unless you do EKG). Same with the stroke; you will not know if the stroke is ischemic or hemorragic or if this even was a stroke. But if I came upon a guy who is having a chest pain, sharp, radiating or non radiating than he would get 2 baby aspirins.

Not if you are acting as of a good will. Good Samaritan laws will protect you unless sleazy lawyer can prove that you intended harm. And he can't unless you were treating your monther-in-law. Reason why a lot of people don't want to deal with it is because if proceedings ever happen it is a drag. I show up on the calls all the time when chest pain victims get ASA from bystanders. No harm done. Never ever in my career I had ASA given to pt for stroke.

Yall need to cut ol Leigh some slack. He is in the UK and they are 10 or so years ahead of us with the nanny state indoctrination. In a decade or so, we too will be afraid to have mere lay people give tylenol for fevers, let alone aspirin for heart attacks.

I always thought it was vice versa...

Leigh,



Perhaps in the U.K., but the majority of those on this forum are in the U.S. where state Good Samaritan laws generally protect those who render aid in circumstances such as this.

I can't say I agree with this advice in every case (trained vs. untrained responders, family vs. unknown victim, etc.), however one interesting thing:

Back when I was a paramedic running ambulance duty, we could give morphine on standing orders but required a direct order to give aspirin.

"Standing orders" mean you are following a defined protocol, but you as the paramedic make the decision to procede or not yourself in the field. "Direct orders" mean you have to radio in to the hospital and get a physicians consent before proceding. The protocols you follow as a paramedic are goverened by your "physician advisor". They decide what you can and cannot do, and what (if any) advance authorization you require before proceding. A different ambulance service than mine could well have given aspirin under standing orders, but had to radio in for a direct order for the morphine. This was many years ago. Maybe protocols are more standardized these days.

NYC is reverse to what you are used to... I can give pretty much anyone 162mg of asa followed by nitro but got to call for Morpheus.

I read in a (non-medical) magazine that a study found that Alka-Seltzer (which contains Asprin) worked ~3 times faster than regular Asprin and therefore may be better in treating suspected heart-attack. I don't know if that was disolving the tablet or chewing it.

Any thoughts/futher info on this? I carry both Asprin and Alka-Seltzer at the moment...

eeph

We use 81mg chewable baby aspirin on the medic unit, giving up to 4 for a total maximum dose of 324mg at the discretion of the medic based upon the patient’s signs/symptoms, medications and history.

Pete

I also take (87mg)aspirin my doctor explained that one a day
was to aid in warding off the event of getting a heart attack
or stroke.

FYI: Dutch EMS-protocol is 500mg I.V.