# ASA...cheweable vs pill



## bryncvp (Jul 21, 2010)

Chest pain in a suspect cardiac patient..first line drug is asprin...does it matter if you give them 4 childrens chewable at 324mg or 1 adult pill that you swallow with water at 325mg?? Is there a different in the aborption or onset of effects with a chewable vs a pill you swallow with water?


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## medic417 (Jul 21, 2010)

They need to chew it so it gets into system quicker.  They can chew adult aspirin but tastes nasty.  

Oh and aspirin is not first drug oxygen is.


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## atticrat (Jul 21, 2010)

Is there a different in the aborption or onset of effects with a chewable vs a pill you swallow with water? 

Yes, the mouth/tounge has alot of vasculature so onset of action is quite rapid. While something taken p/o has to dissolve and be digested.


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## LondonMedic (Jul 21, 2010)

medic417 said:


> Oh and aspirin is not first drug oxygen is.


I find that it's whatever comes to hand first...

And as for an answer, chewable, but I'm not sure how much buccal absorption there is, it's a relatively large molecule.


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## Veneficus (Jul 21, 2010)

just like everything else, something chewed up has more surface area than something condensed into pill form. 

In other words, more absorbtion faster. (agree with London though, probably not buccal)


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## sir.shocksalot (Jul 21, 2010)

atticrat said:


> Is there a different in the aborption or onset of effects with a chewable vs a pill you swallow with water?
> 
> Yes, the mouth/tounge has alot of vasculature so onset of action is quite rapid. While something taken p/o has to dissolve and be digested.


Plus most PO meds are extended release or some such thing, designed to be absorbed over a certain period of time. I read somewhere that ASA was triggered to be absorbed in an acidic environment, so that a low pH changes the structure and allows it to pass into the circulatory system, so I guess all absorption is done in the stomach and little/none done buccally.


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## lampnyter (Jul 21, 2010)

I can not give aspirin under my scope, we can only give NTG for chest pain but we always try to give NTG subdermaly(sp?) because its more vascular so it gets into the system quicker.


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## atticrat (Jul 21, 2010)

subdermaly(sp?) Your thinking sub-lingual S/L under the tounge.  Dermal is the skin.

Also it's nice to snap a 12 lead before any med admin. So if the ALS unit is close to arrival it's helpful when the basics hold off meds just a minute or two.


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## sir.shocksalot (Jul 21, 2010)

lampnyter said:


> I can not give aspirin under my scope, we can only give NTG for chest pain but we always try to give NTG subdermaly(sp?) because its more vascular so it gets into the system quicker.


That's surprising considering the only proven effective treatment for an MI is ASA, and its the only one that has the least potential for adverse reactions, and therefor safer for a basic to give. I would never condone blind BLS admin of NTG.


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## WolfmanHarris (Jul 21, 2010)

lampnyter said:


> I can not give aspirin under my scope, we can only give NTG for chest pain but we always try to give NTG subdermaly(sp?) because its more vascular so it gets into the system quicker.



This confuses the heck out of me.
Is this one of those med-assist things, where really you're just saying "Hey, got some aspirin? Why don't you take some."


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## lampnyter (Jul 21, 2010)

atticrat said:


> subdermaly(sp?) Your thinking sub-lingual S/L under the tounge.  Dermal is the skin.
> 
> Also it's nice to snap a 12 lead before any med admin. So if the ALS unit is close to arrival it's helpful when the basics hold off meds just a minute or two.



yea i meant sublingual lol sorry. And i can also only assist with NTG at the EMT level, they have to have their own for me to give it to them.


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## atticrat (Jul 21, 2010)

If you can possibly wait for the ALS truck I highly recommend waiting to give anything except o2. It's preferable to have a patent lock in place before nitro gets dropped.


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## CAOX3 (Jul 21, 2010)

atticrat said:


> If you can possibly wait for the ALS truck I highly recommend waiting to give anything except o2. It's preferable to have a patent lock in place before nitro gets dropped.



So your requesting EMTs withold ASA in a time sensitive complaint such as MI?

Why would we do that?


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## Shishkabob (Jul 21, 2010)

atticrat said:


> Also it's nice to snap a 12 lead before any med admin. So if the ALS unit is close to arrival it's helpful when the basics hold off meds just a minute or two.



ASA isn't going to change your 12-lead in any way I know of .





sir.shocksalot said:


> I would never condone blind BLS admin of NTG.



Patients give it to themselves all the time without doing their own in-home 12-lead.


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## CAOX3 (Jul 21, 2010)

Linuss said:


> Patients give it to themselves all the time without doing their own in-home 12-lead.



....and their friends, neighbors, relatives and one patient I had even gave it to one of her dogs when he didnt look right.

I dont see NTG administration to a person holding a prescription a problem as long as their systolic is cooperating.  We do it all the time.


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## AnthonyM83 (Jul 22, 2010)

CAO3,

Depending on the type/location/extent of the MI, NTG actually cause a much more dramatic drop in blood pressure than it usually does. In the area that you give it all the time (implied that it's without ALS), is it NTG basics carry or is it a prescribed assist?

I wouldn't delay aspirin at all (as was said, it's the one field drug that can actually really help an MI...though I haven't seen it compared to oxygen, but I imagine still better in most cases?), but I if ALS was very close by I'd agree to hold off until an IV lock can be established first.


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## sir.shocksalot (Jul 22, 2010)

Linuss said:


> Patients give it to themselves all the time without doing their own in-home 12-lead.


They do, and they take it for their treatment of angina, not for the treatment of an MI. Pt's do not usually call if they have angina and are having an episode they they are controlling well with their NTG. They call when something is different, the pain won't go away after an hour, this pain is worse, or the pain is associated with nausea and vomiting. Without ALS assessment of the cause of the pain NTG could cause a dramatic drop in pressure in the presence of an inferior and right lateral wall MIs, which would have been avoided had a 12-lead been performed and evaluated. So I agree that pt's give it to themselves safely all the time, in the setting of a 911 call I think a more thorough evaluation needs to be done before NTG is given.


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## CAOX3 (Jul 22, 2010)

AnthonyM83 said:


> CAO3,
> 
> Depending on the type/location/extent of the MI, NTG actually cause a much more dramatic drop in blood pressure than it usually does. In the area that you give it all the time (implied that it's without ALS), is it NTG basics carry or is it a prescribed assist?.



When I took my class it was carried by BLS providers, where I am employed its assist only and while agree to an extent with your comments the patient who is prescribed NTG isnt aware they may be having an inferior wall MI all they know is their having chest pain and the doctor told them to take it.

So im assuming if in fact it is an inferior wall MI and they took their prescribed nitro their pressure will be in the toilet and we wont be giving it anyway.


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## Shishkabob (Jul 22, 2010)

sir.shocksalot said:


> They do, and they take it for their treatment of angina, not for the treatment of an MI. Pt's do not usually call if they have angina and are having an episode they they are controlling well with their NTG. They call when something is different, the pain won't go away after an hour, this pain is worse, or the pain is associated with nausea and vomiting. Without ALS assessment of the cause of the pain NTG could cause a dramatic drop in pressure in the presence of an inferior and right lateral wall MIs, which would have been avoided had a 12-lead been performed and evaluated. So I agree that pt's give it to themselves safely all the time, in the setting of a 911 call I think a more thorough evaluation needs to be done before NTG is given.



Except, in every circumstance I've ever been in, the patient has already given themselves 3 doses of their nitro prior to our arrival, and as such a "pre-nitro" 12lead is now just wishful thinking.  

They don't know if the pressure in their chest is a pre-load dependent MI or not, they just pop their meds like their doctor has told em.


Trust me, I would MUCH rather have done my assessment before an EMT gives a drug or the patient takes their own, but alas it won't always be the case.


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## sir.shocksalot (Jul 22, 2010)

Linuss said:


> Except, in every circumstance I've ever been in, the patient has already given themselves 3 doses of their nitro prior to our arrival, and as such a "pre-nitro" 12lead is now just wishful thinking.
> 
> They don't know if the pressure in their chest is a pre-load dependent MI or not, they just pop their meds like their doctor has told em.
> 
> ...


I agree, my argument was more against EMTs administering NTG prior to an ALS assessment being done for chest pain. Pt's are going to do their own thing until we show up anyway :wacko:.


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## Shishkabob (Jul 22, 2010)

That's what I'm saying... I'm not against EMTs giving it if ALS is a bit away as the patient would have /already has.  Yes, there's a risk of an RVI bottoming out, but besides those being rare, and bottoming out being rarer, the potential good with a LVI is something that is wanted.


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## jjesusfreak01 (Jul 22, 2010)

You dont have these problems if you run an all ALS ambulance system...


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## CAOX3 (Jul 22, 2010)

jjesusfreak01 said:


> You dint have these problems if you run an all ALS ambulance system...



No because patients with chest pain never empty a bottle of nitro before they call 911 in ALS systems.

The doctor prescribed the nitro for chest pain their just following orders who actually administers it is irrelevant.

And good idea, lets take this discussion down that road....:wacko:


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## medic417 (Jul 22, 2010)

jjesusfreak01 said:


> You dont have these problems if you run an all ALS ambulance system...



I am with you there.  Every patient deserves an assessment by a Paramedic.  Then if the dispatcher screws up thinking BS it doesn't matter because the ambulance she sent has Paramedics.  But we can't live in the dream world.  The politicians will always convince the public they are safe and then use the cheapest way possible which is basics on ambulances.


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## reidnez (Jul 22, 2010)

jjesusfreak01 said:


> You dont have these problems if you run an all ALS ambulance system...



Better yet, go to the German system which puts a physician on every ALS rig...it's an awesome standard of care, I'm sure, but I don't think anyone in the states is going to pony up the cash for that kind of system (unless we can convince enough doctors to work for $30k/yr.) :unsure:


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## WolfmanHarris (Jul 22, 2010)

reidnez said:


> (unless we can convince enough doctors to work for $30k/yr.) :unsure:



EMS isn't underpaid everywhere. I make $70k/yr base, plus excellent benefits and pension based on a 42hr work week. (4 on, 4 off, 6 on, 4 off, 4 on, 6 off). Sure cost of living makes comparison hard, but I am able to live comfortably and support a family on that pay.

It is possible with education.

Whoops. Threadjack. Sorry.


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## atticrat (Jul 22, 2010)

CAOX3 said:


> So your requesting EMTs withold ASA in a time sensitive complaint such as MI?
> 
> Why would we do that?



From my post I said "If you can possibly wait", meaning ALS is within 1-3 minutes, not "Wait forever till the medics arrive".  Should have been more specific.

Yes that's what I'm saying. ASA may not change the 12 lead, but a FULL assessment before meds. is never a bad idea.


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## atticrat (Jul 22, 2010)

Linuss said:


> ASA isn't going to change your 12-lead in any way I know of .
> Maybe.  Our cath lab docs. expect a 12 lead before any interventions by us. If we give a med before a full assessment, they want to know why. You already know a 12 lead dosen't take that long anyway, you can snap one while you partner gets the history. Maybe your system is set up differently.
> 
> 
> ...


Of course they do. But why would you be giving ASA to someone who's used their prescribed nitro? Because something is "different" this time, is usually the answer. Why did they call the ambulance this time? Because something is "different".   You can't control what happens before your arrival, but don't you want to do full diagnostics before you go any further with this patient?


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## Smash (Jul 23, 2010)

medic417 said:


> They need to chew it so it gets into system quicker.  They can chew adult aspirin but tastes nasty.
> 
> Oh and aspirin is not first drug oxygen is.



Would have to respectfully disagree.  Aspirin has a clear and well established benefit in reducing mortality and morbidity in ACS.  Oxygen does not have such evidence and there is some suggestion (although evidence is at best sketchy) that it may cause harm.  Unless the patient is distressed, hypoxemic or has that 'oh carp I'm going to die' look about them I often hold off on the O2 to help me get a better history without having strain to hear the patient.



			
				WolfmanHarris said:
			
		

> EMS isn't underpaid everywhere. I make $70k/yr base, plus excellent benefits and pension based on a 42hr work week. (4 on, 4 off, 6 on, 4 off, 4 on, 6 off). Sure cost of living makes comparison hard, but I am able to live comfortably and support a family on that pay.
> 
> It is possible with education.



That'll never catch on!


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## jjesusfreak01 (Jul 23, 2010)

CAOX3 said:


> No because patients with chest pain never empty a bottle of nitro before they call 911 in ALS systems.
> 
> The doctor prescribed the nitro for chest pain their just following orders who actually administers it is irrelevant.
> 
> And good idea, lets take this discussion down that road....:wacko:



I would expect that a patient with nitro on them probably would have taken it if they could, but my point is really that on an ALS rig you can do a 12-lead before administering nitro, if you wish.


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## clibb (Jul 23, 2010)

reidnez said:


> Better yet, go to the German system which puts a physician on every ALS rig...it's an awesome standard of care, I'm sure, but I don't think anyone in the states is going to pony up the cash for that kind of system (unless we can convince enough doctors to work for $30k/yr.) :unsure:



Those doctors do not work for $30k/yr. They make a lot more. I'd say somewhere between $70,000- $150,000. Which is a TON of money there.


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