# probably a stupid question for po asa



## azerkail (May 22, 2012)

this question keeps coming up on the jblearning test banks about aspirin dosing. i took my class in l.a. county, meaning to say we emt-b's don't get to play around with oral aspirin. is there a document or something that specifically lays out what nremt expects in the aspirin department? 

as far as i understand from clinicals its 4x81mg =324mg for patients reporting chest pain. its contraindications would be suspicion of g.i. bleeds or allergies to aspirin and should never be used for chest pain due to trauma. i'm guessing its because anti-platelet action of asa would decrease clotting and the allergy contraindication is kind of self explanatory.

thanks in advance for answering. its probably stupid but i would like the insight.


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## RemoveTheFear (May 23, 2012)

AHA dosing, which I believe would be valid for the NR, is 160-325mg PO. Pt needs to be able to chew and swallow the ASA with none of the contraindications you have already mentioned.


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## EMTFozzy (Jun 1, 2012)

Usually is childrens from my expierence i have seen!


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## Monkadelic (Jun 2, 2012)

if the patient was already on Coumadin(Warfarin) i probably wouldnt give them aspirin unless absolutely necessary. but thats imo
edit:  id keep ALS in mind if you're not paired with a medic and just transport them and get them to the ER


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## JPINFV (Jun 2, 2012)

Monkadelic said:


> if the patient was already on Coumadin(Warfarin) i probably wouldnt give them aspirin unless absolutely necessary. but thats imo
> edit:  id keep ALS in mind if you're not paired with a medic and just transport them and get them to the ER



Warfarin works along a completely different mechanism and isn't a contraindication to using ASA.


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## Monkadelic (Jun 2, 2012)

JPINFV said:


> Warfarin works along a completely different mechanism and isn't a contraindication to using ASA.


 i know its not a contraindication but i still wouldnt double up on the anti clotting factors; like i said thats just me- unless its a grim situation.  it all boils down to clinical judgement imo. i mean if med direction ordered it i would; but i wouldnt call them asking for permission at the same time. unless you are more than 30 minutes away its not really gonna matter anyways- just get em there and have the medic call a STEMI if you have to


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## JPINFV (Jun 2, 2012)

Monkadelic said:


> i know its not a contraindication but i still wouldnt double up on the anti clotting factors; like i said thats just me- unless its a grim situation.  it all boils down to clinical judgement imo. i mean if med direction ordered it i would; but i wouldnt call them asking for permission at the same time. unless you are more than 30 minutes away its not really gonna matter anyways- just get em there and have the medic call a STEMI if you have to


The sooner ASA is administered, the sooner thromboxane is inhibited, and the smaller the clot is going to be. Furthermore, you recognize that it isn't a contraindication, but are appealing to clinical judgement? What is the basis of your clinical judgement? 

Finally, if less than 30 minutes doesn't matter, why not just hire taxi drivers instead of EMTs?


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## Tigger (Jun 2, 2012)

Monkadelic said:


> i know its not a contraindication but i still wouldnt double up on the anti clotting factors; like i said thats just me- unless its a grim situation.  it all boils down to clinical judgement imo. i mean if med direction ordered it i would; but i wouldnt call them asking for permission at the same time. unless you are more than 30 minutes away its not really gonna matter anyways- just get em there and have the medic call a STEMI if you have to



That line of reasoning makes no sense. It shows a lack of clinical judgement to administer a medication that is clinically indicated when no contraindications are present. 

If you were called onto the carpet by your QA people or medical director for choosing not to give ASA when indicated for a chest pain patient, how far do you think your line of reasoning would get you given that you have no research to support your claim?


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## Medic Tim (Jun 2, 2012)

tigger said:


> that line of reasoning makes no sense. It shows a lack of clinical judgement to administer a medication that is clinically indicated when no contraindications are present.
> 
> If you were called onto the carpet by your qa people or medical director for choosing not to give asa when indicated for a chest pain patient, how far do you think your line of reasoning would get you given that you have no research to support your claim?



+1.


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## lightsandsirens5 (Jun 3, 2012)

Monkadelic said:


> i know its not a contraindication but i still wouldnt double up on the anti clotting factors; like i said thats just me- unless its a grim situation.  it all boils down to clinical judgement imo. i mean if med direction ordered it i would; but i wouldnt call them asking for permission at the same time. unless you are more than 30 minutes away its not really gonna matter anyways- just get em there and have the medic call a STEMI if you have to




Ummmm....med direction HAS ordered it. Assuming you don't still work in the bronze age. Everything in your protocol book has already been approved by your MPD and, if you don't have to call for everything (like I said about the bronze age...or should I say stone age), should be taken as an order from med control. 

Yes...lots lots LOTS more to say here to explain that....but will not hijack thread. Just a word of caution, don't let your cookbook replace good coomon sense judgement. 

So anyhow, if you look up ASA in the AHA guidelines, in other drug guides, in (I HOPE!) your protocols book, you won't see warfarin as a contraindication.

Also, they have a totally different mechanism of action. Warfarin acts by inhibiting the synthesis of factors II, VII, IX and X (I think....) through doing something (though what I cannot recall to save my life) with the inhibition or underproduction of Vitamin-K. In other words, if screws up the clotting cascade. ASA on the other hand inactivates COX enzymes, preventing the formation of thromboxane A2, further preventing the aggregation of platelets, regardless of weather the clotting cascade is in working order or not.

So....two TOTALY different mechanisms of action, which therefore renders the argument of "not stacking up anti-coagulants" absurd. Why should we be afraid they won't clot very well? THAT IS THE POINT!


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## Aidey (Jun 3, 2012)

I've seen MDs order ASA, Plavix and heparin together in AMIs.


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## lightsandsirens5 (Jun 3, 2012)

Aidey said:


> I've seen MDs order ASA, Plavix and heparin together in AMIs.



Seen it yesterday....on an NSTEMI even.


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## azerkail (Jun 7, 2012)

lightsandsirens5 said:


> Also, they have a totally different mechanism of action. Warfarin acts by inhibiting the synthesis of factors II, VII, IX and X (I think....) through doing something (though what I cannot recall to save my life) with the inhibition or underproduction of Vitamin-K. In other words, if screws up the clotting cascade. ASA on the other hand inactivates COX enzymes, preventing the formation of thromboxane A2, further preventing the aggregation of platelets, regardless of weather the clotting cascade is in working order or not.



+1 my other job is a pharmacy technician lol.


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## JPINFV (Jun 7, 2012)

Aspirin, the ultimate cox blocker.


/and that's all folks.


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## Aidey (Jun 7, 2012)

JPINFV said:


> Aspirin, the ultimate cox blocker.
> 
> 
> /and that's all folks.



I literally booooo-ed


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