Aspirin protocol with vomiting patient

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GloriousGabe

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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.
 

RedAirplane

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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?
 

MS Medic

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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.
 

ERDoc

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Zofran and/or aspirin PR.
 
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GloriousGabe

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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?
 

usalsfyre

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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.
 

COmedic17

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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.
 

MS Medic

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

ERDoc

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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.
 

MS Medic

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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.
 

DesertMedic66

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

ViolynEMT

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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.
 

Martyn

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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.
 

chaz90

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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.
 

COmedic17

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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.
 

Tigger

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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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GloriousGabe

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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).
 

chaz90

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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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