ASA...cheweable vs pill

[bryncvp]

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?

 

[medic417]

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.

 

[atticrat]

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.

 

[LondonMedic]

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.

 

[Veneficus]

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)

 

[sir.shocksalot]

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.

 

[lampnyter]

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.

 

[atticrat]

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.

 

[sir.shocksalot]

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.

 

[WolfmanHarris]

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."

 

[lampnyter]

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.

 

[atticrat]

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.

 

[CAOX3]

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?

 

[Shishkabob]

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 .

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.

 

[CAOX3]

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.

 

[AnthonyM83]

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.

 

[sir.shocksalot]

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.

 

[CAOX3]

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.

 

[Shishkabob]

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.

 

[sir.shocksalot]

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.

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:.