Aspirin protocol with vomiting patient

[GloriousGabe]

We definitely get more calls for chest pain where the aspirin protocol is warranted than we do for any sort of anaphylaxis. This is why I wonder why an ASA-Pen doesn't already exist.

 

[chaz90]

Because it's easily chewed in 99% of cases? PO ASA is cheap, readily available, already proven to have rapid absorption and efficacy, and able to be administered by providers of any level with minimal training.

 

[GloriousGabe]

Because it's easily chewed in 99% of cases? PO ASA is cheap, readily available, already proven to have rapid absorption and efficacy, and able to be administered by providers of any level with minimal training.

Except those having an MI who often suffer from intense nausea and vomiting. Plus, an IM administration has a faster absorption than PO. I looked around and it seems IM ASA exists in other countries but not in the US. I think it's time to go with autoinjectors of ASA for aspirin protocols. It will certainly save many lives.

 

[Chewy20]

Except those having an MI who often suffer from intense nausea and vomiting. Plus, an IM administration has a faster absorption than PO. I looked around and it seems IM ASA exists in other countries but not in the US. I think it's time to go with autoinjectors of ASA for aspirin protocols. It will certainly save many lives.

Then go be the guy who gets it approved in the US..."It will certainly save many lives." lol no it won't.

 

[NomadicMedic]

 

[triemal04]

Except those having an MI who often suffer from intense nausea and vomiting. Plus, an IM administration has a faster absorption than PO. I looked around and it seems IM ASA exists in other countries but not in the US. I think it's time to go with autoinjectors of ASA for aspirin protocols. It will certainly save many lives.

Can you go ahead and post some empiric evidence that a) the IM administration of aspirin will be more effective and "save many lives" when compared to the oral administration of same, b) there is an actual need for an alternate route of administration beyond oral and rectal? Thanks, it's much appreciated.

I only ask because...you know...doing something that doesn't serve a purpose, doesn't fill a need and might only be done so that people get to do "cool neato stuff" is a bad idea.

 

[RedAirplane]

It certainly seems plausible to the untrained eye. Isn't nausea/vomiting among the side effects of a heart attack?

 

[chaz90]

It certainly seems plausible to the untrained eye. Isn't nausea/vomiting among the side effects of a heart attack?

It can be, but it's often able to be controlled with anti-emetics. This is anecdotal, but I've never had a conscious STEMI patient in whom I was unable to administer aspirin. A few have taken multiple attempts and some Zofran or Phenergan first. If a patient didn't have any pre-hospitally, a dose was likely administered rectally at the hospital along with IV heparin.

 

[Flying]

Why try to fix what has been studied and isn't broken? Why add the cost and pain of an auto-injector to the equation?

 

[GloriousGabe]

Can you go ahead and post some empiric evidence that a) the IM administration of aspirin will be more effective and "save many lives" when compared to the oral administration of same, b) there is an actual need for an alternate route of administration beyond oral and rectal? Thanks, it's much appreciated.

I only ask because...you know...doing something that doesn't serve a purpose, doesn't fill a need and might only be done so that people get to do "cool neato stuff" is a bad idea.

Guess I got a big research project ahead of me! It does "make sense" especially since patients have MIs are usually having concurrent severe nausea and vomiting thus making their ability to chew and swallow pretty poor. Also, the faster you get ASA in the better the PT will do, but I'll have to do the research in order to actually demonstrate that. I'll let you know in 3-5 years when I got the data.

 

[gotbeerz001]

Hi Gabe. I am glad you are passionate. Instead of lobbying for IM ASA, you may have better luck getting your director to approve nausea control measures... or better yet, go get the requisite training to manage these pts as all of us already do.

 

[reaper]

Cannot even remember the last of that I have not been able to give ASA. Think your looking into things to far. If you are seeing a lot of these pts. Then it may be time to get your medic, so you can treat them!

 

[triemal04]

It certainly seems plausible to the untrained eye. Isn't nausea/vomiting among the side effects of a heart attack?

Weeeeeeell...

Guess I got a big research project ahead of me! It does "make sense" especially since patients have MIs are usually having concurrent severe nausea and vomiting thus making their ability to chew and swallow pretty poor. Also, the faster you get ASA in the better the PT will do, but I'll have to do the research in order to actually demonstrate that. I'll let you know in 3-5 years when I got the data.

I guess you do. Or you could just figure out how often people who will need aspirin also are having vomiting to the point that it can't be given. Here's a hint: it's a very small number. Or you could learn about how aspirin works and who it benefits. Or you could just learn a little more about medicine and what actually happens versus what you learned in a flippin' EMT class.

You proposed something that is not needed, that you don't understand, has no real value, and don't have the background for. Did you not think that you would get shot down pretty quick?

 

[Tigger]

Guess I got a big research project ahead of me! It does "make sense" especially since patients have MIs are usually having concurrent severe nausea and vomiting thus making their ability to chew and swallow pretty poor. Also, the faster you get ASA in the better the PT will do, but I'll have to do the research in order to actually demonstrate that. I'll let you know in 3-5 years when I got the data.

You keep using this word "usually." I think you are looking for "rarely."

 

[GloriousGabe]

You keep using this word "usually." I think you are looking for "rarely."

I disagree. Nausea and/or vomiting are a prevalent feature in MIs.

 

[Tigger]

I disagree. Nausea and/or vomiting are a prevalent feature in MIs.

What do you base this on? Nausea perhaps, but that does not prevent the patient from chewing and swallowing.

If you want to argue for change, you need to prove why it's beneficial. So far you have increased cost and complexity (and some pain) for no demonstrable improvement in outcomes.

 

[GloriousGabe]

What do you base this on? Nausea perhaps, but that does not prevent the patient from chewing and swallowing.

If you want to argue for change, you need to prove why it's beneficial. So far you have increased cost and complexity (and some pain) for no demonstrable improvement in outcomes.

"Nausea was reported in almost 2/3 of all patients, and vomiting in nearly 1/3."
Source: http://www.ajconline.org/article/S0002-9149(09)01469-6/abstract?cc=y=
Relation of Nausea and Vomiting in Acute Myocardial Infarction to Location of the Infarct

If 2/3 are nauseated they are highly unlikely to be able or willing to chew and swallow medication. 1/3 simply can't. That calls for alternate delivery methods.

 

[Tigger]

"Nausea was reported in almost 2/3 of all patients, and vomiting in nearly 1/3."
Source: http://www.ajconline.org/article/S0002-9149(09)01469-6/abstract?cc=y=
Relation of Nausea and Vomiting in Acute Myocardial Infarction to Location of the Infarct

Good try. Please prove to me that those patients were unable to take aspirin. Also, are you aware that ASA is generally absorbed in about five minutes?

 

[GloriousGabe]

Good try. Please prove to me that those patients were unable to take aspirin. Also, are you aware that ASA is generally absorbed in about five minutes?

You want me to prove that someone was unable to do something?
https://en.wikipedia.org/wiki/Proving_a_negative

 

[Jim37F]

I've yet to run on a chest pain patient where they were so nauseated they couldn't take and chew the aspirin....