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#115199 - 12/09/07 04:16 AM Re: Do you carry aspirin? [Re: teacher]
TQS Offline
Member

Registered: 03/12/06
Posts: 141
Loc: Humboldt County, CA
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.
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#115201 - 12/09/07 04:29 AM Re: Do you carry aspirin? [Re: TQS]
Alan_Romania Offline

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Registered: 06/29/05
Posts: 648
Loc: Arizona
Originally Posted By: TQS
...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.
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#115204 - 12/09/07 05:18 AM Re: Do you carry aspirin? [Re: Alan_Romania]
marduk Offline
Member

Registered: 01/25/04
Posts: 160
Loc: Mid-Missouri
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


Edited by marduk (12/09/07 05:30 AM)
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#115206 - 12/09/07 06:04 AM Re: Do you carry aspirin? [Re: Alan_Romania]
Leigh_Ratcliffe Offline
Veteran

Registered: 03/31/06
Posts: 1355
Loc: United Kingdom.
Originally Posted By: Alan_Romania
Originally Posted By: Leigh_Ratcliffe
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,

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.


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.
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#115256 - 12/09/07 10:49 PM Re: Do you carry aspirin? [Re: Leigh_Ratcliffe]
Russ Offline
Geezer

Registered: 06/02/06
Posts: 5357
Loc: SOCAL
Originally Posted By: Leigh_Ratcliffe
. . .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?
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Okay, what’s your point??

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#115270 - 12/10/07 12:00 AM Re: Do you carry aspirin? [Re: Leigh_Ratcliffe]
Polak187 Offline
Veteran

Registered: 05/23/02
Posts: 1403
Loc: Brooklyn, New York
Originally Posted By: Leigh_Ratcliffe
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.


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.
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http://brunerdog.tripod.com/survival/index.html

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#115271 - 12/10/07 12:09 AM Re: Do you carry aspirin? [Re: Russ]
Polak187 Offline
Veteran

Registered: 05/23/02
Posts: 1403
Loc: Brooklyn, New York
Originally Posted By: RAS
Originally Posted By: Leigh_Ratcliffe
. . .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?


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.
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Matt
http://brunerdog.tripod.com/survival/index.html

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#115325 - 12/10/07 02:54 AM Re: Do you carry aspirin? [Re: Polak187]
duckear Offline
Addict

Registered: 03/01/04
Posts: 478
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.

frown



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#115343 - 12/10/07 11:29 AM Re: Do you carry aspirin? [Re: duckear]
Polak187 Offline
Veteran

Registered: 05/23/02
Posts: 1403
Loc: Brooklyn, New York
I always thought it was vice versa...
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Matt
http://brunerdog.tripod.com/survival/index.html

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#115350 - 12/10/07 12:46 PM Re: Do you carry aspirin? [Re: Leigh_Ratcliffe]
Doug_Ritter Offline

Pooh-Bah

Registered: 01/28/01
Posts: 2198
Leigh,

Originally Posted By: Leigh_Ratcliffe
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.


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.
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