Aspirin protocol with vomiting patient

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NomadicMedic

NomadicMedic

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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

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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?
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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

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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....
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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

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Tigger said:
Also, are you aware that ASA is generally absorbed in about five minutes?
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5 minutes is on the extreme low side. The actual absorbability is between 5 and 30 minutes.
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Flying

Flying

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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.
 
MS Medic

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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....
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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

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

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

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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

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

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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.
 
MS Medic

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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?
 
MS Medic

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

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