# Aspirin protocol with vomiting patient



## GloriousGabe (Dec 14, 2015)

I had a recent patient who had all the signs and symptoms of an active MI. PT had previously had 3 MIs and several stents placed. The 12-lead EKG showed STEMI in multiple leads and "ACUTE MI" on the computer interpretation. We attempted to give the PT aspirin per our protocols but the PT was extremely nauseated and vomited several times en route to the ER. 

I didn't force the issue and didn't try to convince her to take the aspirin despite vomiting. My question is: how much should I have convinced the PT to take the aspirin? I understand it definitely reduces mortality and befits coronary perfusion. Is it something where I should have really encouraged the PT to chew and swallow or let it go? I have heard that aspirin is absorbed through the stomach so could it benefit the patient even if they were to vomit 5 minutes after swallowing the aspirin?

Your thoughts are appreciated. Thank you.


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## RedAirplane (Dec 14, 2015)

My understanding is that if the patient has vomited, do not give anything by mouth for at least thirty minutes. Then begin with sips of water--up to 4oz every thirty minutes. 

As for the issue of a coexistent MI, I would punt to a paramedic's discretion. Is there some way to give medication by IV?


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## MS Medic (Dec 14, 2015)

This is one of those gray moments where you have to do what you can. If the pt is vomiting and can't hold it down, then there isn't a lot you can do. I've hauled a STEMI pt who had AMS in without anything other than a IV done because we don't have IV NTG and the pt wasn't coherent enough to attempt anything PO. You have to just do the best you can sometimes.

I assume you work in an ALS sprint system. Since I work in a system where all ambulances are ALS, this is pure speculation, but call for an ALS unit and initiate transport. If you get an intercept before reaching the hospital, the medic takes over and there are more options. If not, get them to the hospital because a cath lab does a lot better job of increasing perfusion and  decreasing mortality than ASA.


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## ERDoc (Dec 14, 2015)

Zofran and/or aspirin PR.


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## GloriousGabe (Dec 14, 2015)

I work on a BLS service. We occasionally can get an ALS intercept but that's only when the regional ALS provider isn't busy on another call, so IV-anything isn't an option.

PR=by rectum. Are you kidding?


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## usalsfyre (Dec 14, 2015)

GloriousGabe said:


> PR=by rectum. Are you kidding?



Nah, how do you think ROSC patient's get ASA? Magic?

ASA's benefit is a 24 hour thing, so while you want to get it on-board early, if you can't control the nausea let the ED handle it. Just make sure you PASS ALONG that you weren't able to give it.


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## COmedic17 (Dec 14, 2015)

Zofran first, then ASA. Do you have sublingual zofran? 

But ASA isn't some miracle drug that produces a rapid response, so I wouldn't be too concerned if they were unable to take it.


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## ERDoc (Dec 15, 2015)

GloriousGabe said:


> PR=by rectum. Are you kidding?




Uhm, no.  Why?


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## MS Medic (Dec 15, 2015)

He probably doesn't have protocols to administer anything rectal.


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## ERDoc (Dec 15, 2015)

I can understand that, it is just the way it was expressed, like it was some foreign concept.  Maybe I am misreading it since emotion never comes across well in a forum.


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## MS Medic (Dec 15, 2015)

Working in a BLS system, it very well might be a completely alien concept to him. To be honest, I'd never heard of it before. It just makes enough sense to me that I'm not shocked by it.


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## DesertMedic66 (Dec 15, 2015)

We covered PR med admin in medic school but that is the extent of it. We have zero protocols for it here


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## ViolynEMT (Dec 15, 2015)

COmedic17 said:


> Zofran first, then ASA. Do you have sublingual zofran?
> 
> But ASA isn't some miracle drug that produces a rapid response, so I wouldn't be too concerned if they were unable to take it.



Sublingual Zofran would be great, but it's not within the scope of practice for EMTs in most (if not all) states.


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## Martyn (Dec 15, 2015)

Really? Swallow aspirin? What are the quickest ways to get a drug in the body? SUBLINGUAL!!! (One of them anyways). They don't SWALLOW the asa, it's chewed and kept under the tongue.


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## chaz90 (Dec 15, 2015)

Martyn said:


> Really? Swallow aspirin? What are the quickest ways to get a drug in the body? SUBLINGUAL!!! (One of them anyways). They don't SWALLOW the asa, it's chewed and kept under the tongue.


Sublingual is fairly quick if the drug in question is designed for mucosal absorption, and ASA is not. Patients are told to chew and swallow aspirin. If you tell them to keep it under their tongue instead, you're doing it wrong. Much of the chewable aspirin kind of dissolves into a paste and is swallowed automatically during the process of chewing.


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## COmedic17 (Dec 15, 2015)

ViolynEMT said:


> Sublingual Zofran would be great, but it's not within the scope of practice for EMTs in most (if not all) states.


EMT's here can start IV's, run fluid, and give a handful of drugs. They have their IV and EKG certs.


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## Tigger (Dec 15, 2015)

Martyn said:


> Really? Swallow aspirin? What are the quickest ways to get a drug in the body? SUBLINGUAL!!! (One of them anyways). They don't SWALLOW the asa, it's chewed and kept under the tongue.


That is not how you give ASA at all. 

I'm still trying to figure out why Zofran ODTs aren't an EMT scope medication, we have it here with no issues. Soon to have IV as well, but Colorado is "different..."


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## ViolynEMT (Dec 15, 2015)

COmedic17 said:


> EMT's here can start IV's, run fluid, and give a handful of drugs. They have their IV and EKG certs.



Not in Az at least. Only in the ED.


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## GloriousGabe (Dec 16, 2015)

I work in a strictly BLS system. Having an aspirin protocol is considered really advanced. Our ASA protocol doesn't provide for sublingual administration and I think it might be a deviation of protocols to suggest a PT do that.

If ASA is so important why isn't there IM ASA? We could use an autoinjector like we do with the EpiPens (which are in our protocols and we carry both adult and junior).


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## chaz90 (Dec 16, 2015)

GloriousGabe said:


> If ASA is so important why isn't there IM ASA? We could use an autoinjector like we do with the EpiPens (which are in our protocols and we carry both adult and junior).


Devising a new formulation of a drug isn't quite that simple. There are regulatory hurdles, studies to set up, review boards to form, and clinical trials to perform, all after the actual drug is created. 

IV aspirin exists, but I believe it is pretty rare. I don't know if it's expensive to produce, not approved for use in the US, or just less effective, but I've only read about it a few times. I have no idea if IM ASA is even a thing.


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## GloriousGabe (Dec 16, 2015)

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.


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## chaz90 (Dec 17, 2015)

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.


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## GloriousGabe (Dec 17, 2015)

chaz90 said:


> 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.


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## Chewy20 (Dec 17, 2015)

GloriousGabe said:


> 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.


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## NomadicMedic (Dec 17, 2015)




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## triemal04 (Dec 17, 2015)

GloriousGabe said:


> 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.


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## RedAirplane (Dec 17, 2015)

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


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## chaz90 (Dec 17, 2015)

RedAirplane said:


> 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.


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## Flying (Dec 17, 2015)

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?


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## GloriousGabe (Dec 18, 2015)

triemal04 said:


> 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.


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## gotbeerz001 (Dec 18, 2015)

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.


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## reaper (Dec 18, 2015)

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!


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## triemal04 (Dec 18, 2015)

RedAirplane said:


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


Weeeeeeell...


GloriousGabe said:


> 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?


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## Tigger (Dec 19, 2015)

GloriousGabe said:


> 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."


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## GloriousGabe (Dec 19, 2015)

Tigger said:


> 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.


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## Tigger (Dec 19, 2015)

GloriousGabe said:


> 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.


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## GloriousGabe (Dec 19, 2015)

Tigger said:


> 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.


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## Tigger (Dec 19, 2015)

GloriousGabe said:


> "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?


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## GloriousGabe (Dec 19, 2015)

Tigger said:


> 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


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## Jim37F (Dec 19, 2015)

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


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## NomadicMedic (Dec 19, 2015)

Since we seem to research anything to do with ACS to death, do you think there might be a study that shows correlation of inability to ingest PO ASA in the field with increased mortality?

Right, because there's not. We give it in the field PO because it's quick, easy, usually well tolerated and inexpensive. If, on the off chance they can not tolerate PO ASA, they get it PR in the ED.


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## GloriousGabe (Dec 19, 2015)

DEmedic said:


> Since we seem to research anything to do with ACS to death, do you think there might be a study that shows correlation of inability to ingest PO ASA in the field with increased mortality?



It's unnecessary to do that research as the inverse already exists.

"Aspirin is simple to administer,
relatively safe, and remarkable effective as
an adjunct in reducing mortality for AMI."
Source: http://www.ct.gov/dph/lib/dph/ems/pdf/training/asa_connecticut_training_(kansas_program).pdf

Therefore there is no need to research what you suggest.


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## GloriousGabe (Dec 19, 2015)

Jim37F said:


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



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.


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## GloriousGabe (Dec 19, 2015)

Tigger said:


> Also, are you aware that ASA is generally absorbed in about five minutes?



5 minutes is on the extreme low side. The actual absorbability is between 5 and 30 minutes.


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## Flying (Dec 19, 2015)

Not sure where you're going with this. To have an autoinjector one gives up aspirin's low cost and the patient's comfort for a rare situation (nausea 2ndary to MI severe enough to preclude PO) that is already addressed by PR administration.

Sure quick aspirin admin improves outcomes, but we're really not doing great in the cost/benefit department within the basic concept of our new intervention. First, let's start bypassing the ER for PCI alert and intervention in the case of STEMI, then let's start talking about more fancy tools for EMTs.


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## teedubbyaw (Dec 19, 2015)

GloriousGabe said:


> 5 minutes is on the extreme low side. The actual absorbability is between 5 and 30 minutes.
> View attachment 2580



Platelet inhibition has been shown to begin in as little as 0.6 minutes. 

This whole thread is a cluster. Not sure why everyone is off the rails when the answer is put in the pooper. Put everything in the pooper when in doubt. Even the ET tube.


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## Jim37F (Dec 19, 2015)

teedubbyaw said:


> Put everything in the pooper when in doubt. Even the ET tube.


I'd pay money to see the look on the face of whoever is QA/QI'ing that chart XD


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## GloriousGabe (Dec 19, 2015)

teedubbyaw said:


> Platelet inhibition has been shown to begin in as little as 0.6 minutes.



Proof please.


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## MS Medic (Dec 19, 2015)

Jim37F said:


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



I've had it happen a few times. Once was a pt who was AMS and having a STEMI. The other couple were actual N/V. But is is such an aberrance that the cost of a specific tool in the box for this isn't cost effective. Since this is one of those things like strokes and trauma where the definitive treatment is a form of surgical intervention, AKA a cath lab, your better off just getting them to the hospital than playing around on scene.


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## GloriousGabe (Dec 19, 2015)

MS Medic said:


> I've had it happen a few times. Once was a pt who was AMS and having a STEMI. The other couple were actual N/V. But is is such an aberrance that the cost of a specific tool in the box for this isn't cost effective.



2/3 of MI patients have nausea, 1/3 have vomiting. That's not an aberrance.


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## MS Medic (Dec 19, 2015)

But where they are so nauseous they can't intake PO ASA is.


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## GloriousGabe (Dec 19, 2015)

MS Medic said:


> But where they are so nauseous they can't intake PO ASA is.



Proof please.


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## MS Medic (Dec 19, 2015)

10 years of treating MI pt where you probably see in excess of 50 a year and having this problem so infrequently that I can count them all on one hand is proof enough for me. 

As was stated by DEmedic earlier, ACS is a heavily researched topic and if an ASA auto-injector was a cost effective and effical solution than someone would have come up with it earlier.


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## GloriousGabe (Dec 19, 2015)

MS Medic said:


> 10 years of treating MI pt where you probably see in excess of 50 a year and having this problem so infrequently that I can count them all on one hand is proof enough for me.
> 
> As was stated by DEmedic earlier, ACS is a heavily researched topic and if an ASA auto-injector was a cost effective and effical solution than someone would have come up with it earlier.



https://en.wikipedia.org/wiki/Anecdotal_evidence


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## Flying (Dec 19, 2015)

GloriousGabe said:


> https://en.wikipedia.org/wiki/Anecdotal_evidence


Ironic, you provided an n=1 anecdote in your original post, yet others cannot use the same method to refute it?

https://the5conflicts.wordpress.com/2014/05/26/more-on-ems-and-adult-tables/


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## GloriousGabe (Dec 20, 2015)

Flying said:


> Ironic, you provided an n=1 anecdote in your original post, yet others cannot use the same method to refute it?
> 
> https://the5conflicts.wordpress.com/2014/05/26/more-on-ems-and-adult-tables/



I've since cited published, peer-reviewed papers which indicate the prevalence of nausea (2/3) and vomiting (1/3) in MI patients.


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## Flying (Dec 20, 2015)

But we're discussing how many of these patients truly can't tolerate ASA and how many of these specific patients are around to warrant an intervention that is less benign and probably not very much more effective than what's already around.


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## MS Medic (Dec 20, 2015)

Well then since anecdotal evidence isn't acceptable can you so me a study that lends credence to the efficacy of IV/IM ASA over PO ASA?


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## MS Medic (Dec 20, 2015)

Flying said:


> But we're discussing how many of these patients truly can't tolerate ASA and how many of these specific patients are around to warrant an intervention that is less benign and probably not very much more effective than what's already around.



And under those circumstances anecdotal evidence is acceptable since your bringing up a purely hypothetical situation.


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## GloriousGabe (Dec 20, 2015)

MS Medic said:


> Well then since anecdotal evidence isn't acceptable can you so me a study that lends credence to the efficacy of IV/IM ASA over PO ASA?



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


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## chaz90 (Dec 20, 2015)

GloriousGabe said:


> 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.


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## MS Medic (Dec 20, 2015)

Flying, that link you posted was a good read.


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## ERDoc (Dec 20, 2015)

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.


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## Carlos Danger (Dec 20, 2015)

GloriousGabe said:


> 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.


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## GloriousGabe (Dec 21, 2015)

Remi said:


> 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"?


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## TransportJockey (Dec 21, 2015)

GloriousGabe said:


> 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.


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## gotbeerz001 (Dec 21, 2015)

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.


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## GloriousGabe (Dec 21, 2015)

TransportJockey said:


> 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*


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## MS Medic (Dec 21, 2015)

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.


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## GloriousGabe (Dec 21, 2015)

MS Medic said:


> 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.


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## Jim37F (Dec 21, 2015)

GloriousGabe said:


> 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..


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## GloriousGabe (Dec 21, 2015)

Jim37F said:


> 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.


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## reaper (Dec 21, 2015)

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.


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## GloriousGabe (Dec 21, 2015)

reaper said:


> 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.


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## ERDoc (Dec 21, 2015)

GloriousGabe said:


> 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.


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## DesertMedic66 (Dec 21, 2015)

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.


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## reaper (Dec 21, 2015)

GloriousGabe said:


> 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!
> 
> ...



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.


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## chaz90 (Dec 21, 2015)

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.


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## TransportJockey (Dec 21, 2015)

Progressive bls? Soinds like typical nm and texas bls.

Get permission to carry odt zofran then


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## triemal04 (Dec 21, 2015)

GloriousGabe said:


> 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.

*<moderator snip>*


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## COmedic17 (Dec 21, 2015)

The EMT's here can start IV's  and give zofran. 

Instead of being so set on creating an ASA auto injector, why wouldn't you just ask your medical director to allow EMT's to obtain/use IV certifications and administer zofran? 


It solves the problem, and makes way more sense.


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## COmedic17 (Dec 21, 2015)

triemal04 said:


> 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. *



Despite everything, I really don't think he/she would.


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## GloriousGabe (Dec 21, 2015)

triemal04 said:


> For someone who says they are 40, you sure are acting more like a petulant 10 year old who thinks they are the center of the universe, and here's why:  you actually think that this is such a huge problem and nobody else has had the smarts to recognize it and come up with a (money making) plan to fix it.  Despite nothing that you are so worked up about being a new thing.   Kiddo...grow up.


https://en.wikipedia.org/wiki/Ad_hominem


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## GloriousGabe (Dec 21, 2015)

ERDoc said:


> 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.


I imagine you'll donate the funds to bring up full-time, salaried paramedics? We just don't have the tax money for that. My town and the one next door don't even have police departments.


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## GloriousGabe (Dec 21, 2015)

DesertMedic66 said:


> 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.



How much time have you spent in very rural America? It's the reality here. Our closest doc-in-a-box is 30 minutes away. STEMIs either die in our ER or they are flown to the trauma center a 2 hour drive away.


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## GloriousGabe (Dec 21, 2015)

chaz90 said:


> 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.


I'll report back in 3-5 years with my peer-reviewed, published results.


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## triemal04 (Dec 21, 2015)

COmedic17 said:


> Despite everything, I really don't think he/she would.


Most likely not; my ego isn't *that* big.  On the flip side, there are a surprising number of medical directors out there who are very involved in their departments and do care about how there people comport themselves, both on and off duty, and also care about how much their people understand about medicine.  Makes sense really.


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## Jim37F (Dec 21, 2015)

GloriousGabe said:


> I imagine you'll donate the funds to bring up full-time, salaried paramedics? We just don't have the tax money for that. My town and the one next door don't even have police departments.


But you have the  time, money, energy, etc to invest into attempting to invent a new medicine. Why not invest that in yourself, and become a Paramedic (heck for that kind of resource investment you could probably become an RN or even a PA depending...) and be able to provide care leaps and bounds above and beyond an IM ASA autoinjector?


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## GloriousGabe (Dec 21, 2015)

Jim37F said:


> But you have the  time, money, energy, etc to invest into attempting to invent a new medicine. Why not invest that in yourself, and become a Paramedic (heck for that kind of resource investment you could probably become an RN or even a PA depending...) and be able to provide care leaps and bounds above and beyond an IM ASA autoinjector?



Closest medic school is 3 hours away. I don't have any money, but I do have a little bit of time and energy. Why are you personalizing this? I'm not.


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## Carlos Danger (Dec 21, 2015)

GloriousGabe said:


> I'll report back in 3-5 years with my peer-reviewed, published results.


I am looking very forward to seeing the results of your clinical and market trials.


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## GloriousGabe (Dec 21, 2015)

Remi said:


> I am looking very forward to seeing the results of your clinical and market trials.


As am I.


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## reaper (Dec 21, 2015)

I always love the we are rural and you obviously have never worked rural areas. We have no tax base or money.  These are all excuses, not to make changes.

I have worked rural areas in many States. Every one of them were ALS systems. It can and is done daily. 

I too think this thread is a dead issue.


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## DesertMedic66 (Dec 21, 2015)

GloriousGabe said:


> How much time have you spent in very rural America? It's the reality here. Our closest doc-in-a-box is 30 minutes away. STEMIs either die in our ER or they are flown to the trauma center a 2 hour drive away.


We do cover a rural area where the closest hospital is at least an hour away and the closest STEMI center is at least 2 hours away. Still an ALS system.


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## GloriousGabe (Dec 21, 2015)

DesertMedic66 said:


> We do cover a rural area where the closest hospital is at least an hour away and the closest STEMI center is at least 2 hours away. Still an ALS system.


That's great! I'll just tell my service about that and I'm sure they'll implement it with no problems.


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## NomadicMedic (Dec 21, 2015)

GloriousGabe said:


> That's great! I'll just tell my service about that and I'm sure they'll implement it with no problems.



How long have you been an EMT?


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## GloriousGabe (Dec 21, 2015)

DEmedic said:


> How long have you been an EMT?


Got my EMT in the late 90s. Yourself?


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## NomadicMedic (Dec 21, 2015)

1988. 

Hahah. I'm done with this before I get whacked with the ban hammer.


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## DesertMedic66 (Dec 21, 2015)

DEmedic said:


> 1988.
> 
> Hahah. I'm done with this before I get whacked with the ban hammer.


EMT 4 Lyfe!!!!


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## chaz90 (Dec 21, 2015)

And on that note, we're done.


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