Aspirin protocol with vomiting patient

[chaz90]

That will have to be studied and I promise to post my peer-reviewed, published results in 3-5 years.

Oh boy. In that case, we eagerly await your results. Best of luck.

 

[MS Medic]

Flying, that link you posted was a good read.

 

[ERDoc]

Let's take a step back and rethink this. Gabe, what exactly is he question you are trying to answer? If you are going to design a study, you must have a question you want to answer. You have provided a study that says that 2/3 of all STEMIs have nausea and 1/3 have vomiting. Are we also going to look at NSTEMIs? You also have to ask a question that is clinically relevant. Just because 2/3 of the pts were nauseous does not mean that they could not tolerate PO ASA. This could be a good starting point for a study:

Does the nausea and vomiting associated with a STEMI prevent oral administration of aspirin?

You don't need that panacea of research, the double-blinded placebo controlled study, to answer this question. This is easily answered with a retrospective chart review and, conveniently ASA administration in STEMIs are a core measure and very well tracked. You may say that MS Medic's experience in 10 year is anecdotal, but when you have several people with several decades of experience, including myself, who raise that N=1 to N=several hundreds or thousands it becomes much more meaningful than just your anecdotal evidence of one case. It is almost becomes a retrospective chart review.

 

[Carlos Danger]

I had one just the other night, which is why I brought up this thread. As nausea and vomiting is extremely common in those having an MI it warrants discussion on how to get ASA into them as quickly as possible using alternate methods than PO.

The bottom line is that you are making a big deal out of a problem that doesn't exist.

As others have pointed out, N&V to the extent that PO ASA can't be taken is uncommon. I've personally never seen it, neither have several other participants in this thread, and collectively we might be closing in on a hundred years of experience. And when such severe nausea does happen, we already have cheap, effective ways to deal with it.

If there were a need for an ASA autoinjector, it would already be in the market. The reason one is it not on the market is because there is no demand for one. The reason there is no demand for one is because there are cheaper, simpler, effective alternatives.

 

[GloriousGabe]

The bottom line is that you are making a big deal out of a problem that doesn't exist.

Except that is very much exists. 1/3 of MI patients are vomiting. 2/3 have nausea. How does this qualify as "doesn't exist"?

 

[TransportJockey]

Except that is very much exists. 1/3 of MI patients are vomiting. 2/3 have nausea. How does this qualify as "doesn't exist"?

Because if they're being treated appropriately, by an als provider, we can give them cheap medications so they're not nauseous and they stop vomiting. And in my experience, the amount of true mi patients that are vomiting is much lower than 1/3.

 

[gotbeerz001]

Gabe, in your 24 post history, many seem to be doing just one thing...

Go make an auto injector. You don't need our approval. If it catches on, you win.

 

[GloriousGabe]

Because if they're being treated appropriately, by an als provider, we can give them cheap medications so they're not nauseous and they stop vomiting. And in my experience, the amount of true mi patients that are vomiting is much lower than 1/3.

My system is strictly BLS. ALS intercept is rare tho it does happen when the one medic for our three counties is available.

Your experience does not trump published, peer-reviewed journals that actually quantify the numbers, being as high as 69%.
Source:
Primary Care Medicine: Office Evaluation and Management of the Adult Patient

 

[MS Medic]

Ask yourself a couple of serious questions.

1) How long have I been doing this compared to the people I'm talking to here?

2) What gives me a better perspective than the people I'm talking to who have been doing this a long time, have more education on the subject and more practical experience dealing with this?

3) What gives me a better perspective than research doctors and PHDs who specialize in this area and apparently haven't found it significant enough to persue?

If you don't have legitimate answers to all three, you're probably beating a dead horse.

 

[GloriousGabe]

Ask yourself a couple of serious questions.

1) How long have I been doing this compared to the people I'm talking to here?

I don't actually know who any of you are so I don't actually know how long anyone has been in EMS or if they actually are in EMS at all.

2) What gives me a better perspective than the people I'm talking to who have been doing this a long time, have more education on the subject and more practical experience dealing with this?

I'll go with the peer-reviewed, published journal articles over anecdotal reports.

3) What gives me a better perspective than research doctors and PHDs who specialize in this area and apparently haven't found it significant enough to persue?

I am obtaining all of my sources from peer-reviewed, published articles. I don't automatically believe someone just because they have a PhD. They would be an appeal to authority which is a logical fallacy.

If you don't have legitimate answers to all three, you're probably beating a dead horse.

Nope.

 

[Jim37F]

Except that is very much exists. 1/3 of MI patients are vomiting. 2/3 have nausea. How does this qualify as "doesn't exist"?

Because there is a difference between being nauseated and being unable to chew and swallow 2 or 3 small pills. Haven't you ever been sick where you've felt like you wanted to puke but were still able to eat some chicken noodle soup? Especially when medics already have easy access to anti-emetics like zofran, it becomes even more of a non issue.

But if you wanna spend all that money and go through all that trouble to start studies and get a brand new medical device invented, patented, studied and trialed and eventually approved for use, and then get medical directors to modify their protocols to allow BLS to carry it, by all means go ahead. Just remember in a lot of places BLS can't even carry auto injectors and have to rely on assisting patients with their own auto injector.....or that you are literally the only one on this thread arguing in favor of this new idea should give you an idea of what the larger medical community's ideas on this will be, and what a steep hill you will have in justifying to others to get this created..

 

[GloriousGabe]

Because there is a difference between being nauseated and being unable to chew and swallow 2 or 3 small pills. Haven't you ever been sick where you've felt like you wanted to puke but were still able to eat some chicken noodle soup?

No way. When I feel like I'm gonna puke I can't swallow anything.

Especially when medics already have easy access to anti-emetics like zofran, it becomes even more of a non issue.

Why do you assume I have a medic available? There is one medic available for the three counties that are part of my BLS system. We see the medic so infrequently.

But if you wanna spend all that money and go through all that trouble to start studies and get a brand new medical device invented, patented, studied and trialed and eventually approved for use, and then get medical directors to modify their protocols to allow BLS to carry it, by all means go ahead.

That's the plan!

Just remember in a lot of places BLS can't even carry auto injectors and have to rely on assisting patients with their own auto injector.....

We already carry adult and pediatric EpiPens. We also have nasal narcan and PO ASA. We're a "progressive" BLS system.

or that you are literally the only one on this thread arguing in favor of this new idea should give you an idea of what the larger medical community's ideas on this will be, and what a steep hill you will have in justifying to others to get this created..

The entire medical community once told Louis Pasteur that he could never kill something no one could see.

 

[reaper]

You would have time better spent by improving your own system. Your pts deserve more then minimal care.

Plus, you need to learn not to put all your faith in "peer reviewed study's" . You will learn over time that one study means nothing. You can make a studies outcome say anything you want. The study you posted had 180 pts in it. That is a very low subject matter to study and say this is evidence-based.

 

[GloriousGabe]

You would have time better spent by improving your own system. Your pts deserve more then minimal care.

Would you like the name and number of our project medical director? I bet he'd just love to hear from you.

Plus, you need to learn not to put all your faith in "peer reviewed study's" . You will learn over time that one study means nothing. You can make a studies outcome say anything you want. The study you posted had 180 pts in it. That is a very low subject matter to study and say this is evidence-based.

I'll place more faith in peer-reviewed, published medical articles over most anything else any day of the week. Also, an apostrophe doesn't pluralize a word.

 

[ERDoc]

We already carry adult and pediatric EpiPens. We also have nasal narcan and PO ASA. We're a "progressive" BLS system.

Do you know what makes a system a truly progressive BLS system? One that realizes it is 2015 and recognizes the need to become a fully functional ALS system.

 

[DesertMedic66]

As a progressive BLS system you should be able to talk to your medical director and have him consider placing Zofran into your scope of practice. That is a much faster route of dealing with the issue you are facing compared to making, testing, and approval of a new medical device.

Also 1 medic in 3 counties that you hardly see and you have BLS providers being the sole providers for STEMI patients? I hope all of your hospitals are very close.

 

[reaper]

Would you like the name and number of our project medical director? I bet he'd just love to hear from you.

You are such a great medical mind. You should be able to handle your own medical director!


I'll place more faith in peer-reviewed, published medical articles over most anything else any day of the week. Also, an apostrophe doesn't pluralize a word.

You do that. See, some of us work and respond via cell phones. Spell check tends to change things that might slip by. But, thank you for your knowledge of the English language.

 

[chaz90]

Can we all agree that this thread is going nowhere? I don't know if there is much more legitimate discussion to be had regarding the majority opinion on the need for ASA auto injectors, but GloriousGabe is clearly entrenched in his belief. At this point, I think he will need to be convinced by additional experience or someone that is not us.

I, for one, am going to bow out of this thread.

 

[TransportJockey]

Progressive bls? Soinds like typical nm and texas bls.

Get permission to carry odt zofran then

 

[triemal04]

Would you like the name and number of our project medical director? I bet he'd just love to hear from you.
I'll place more faith in peer-reviewed, published medical articles over most anything else any day of the week. Also, an apostrophe doesn't pluralize a word.

Why yes, yes in fact I would love to have the name and contact information for your medical director. I think he'd very much like to hear from me on this.

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