Did i mess up will.i get fired

W1IM said:
Just a point of interest - after reading this thread and seeing the vehement opposition to ASA for a patient on blood thinners, I couldn't remember that being a contraindication in my state. I checked the MA protocols on ASA and found that the only contraindication listed is an active GI bleed.

So by the numbers, a patient on blood thinners with suspected cardiac related chest pain would get 324mg of aspirin, so long as they didn't have a GI Bleed. Sounds like we are an outlier here.
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But common sense should tell you that someone who potentially has a head bleed and is at an increased risk of a head bleed shouldn't get something that would make bleeding worse.
 
W1IM said:
Just a point of interest - after reading this thread and seeing the vehement opposition to ASA for a patient on blood thinners, I couldn't remember that being a contraindication in my state. I checked the MA protocols on ASA and found that the only contraindication listed is an active GI bleed.

So by the numbers, a patient on blood thinners with suspected cardiac related chest pain would get 324mg of aspirin, so long as they didn't have a GI Bleed. Sounds like we are an outlier here.
Click to expand...
Why would it be contraindicated for a GI bleed but not a potential head bleed in your area?
 
StCEMT said:
Why would it be contraindicated for a GI bleed but not a potential head bleed in your area?
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Because that's way too much information for poor lil Basics. After all, why consider MOI plus underlying conditions such as age, Hx and existing medications if you can just do it by the book ?
 
Just thinking outloud here... As an EMT-B and EMS in general, it's a very logical process.. Somebody is bleeding stop the bleeding, not make the bleeding worse. If they can't breathe, we try to get them to breathe or breathe for them... we don't suffocate them. Giving anything that would thin the blood makes 0 sense in the EMS setting. Let the docs figure out what they want to do. AT A VERY MINIMUM call the doctors and ask. This logic must be present even if you disregard history(which you should not do for the record*)
 
ERDoc said:
But common sense should tell you that someone who potentially has a head bleed and is at an increased risk of a head bleed shouldn't get something that would make bleeding worse.
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I understand what everyone os saying. to me she did not seem to have a head bleed based on what i saw. she had no naseau, was alert and oriented wasnt stuttering or sluring words. she was all in all fine beside her grabbing her chest. gonna go back and review all the aspects of aspirin. i did not think that 4 baby aspirins would cause that much damage when her problem was her chest. but thats my fault. i was always taught that aspirin does not thin the blood but just makes it "slippery"
 
Couple of things

OP said the chest pain caused the fall. So that would be atraumatic pain. However, the contusion over her eye would be a contraindication based on NJ protocols:

Known hypersensitivity
325mg ASA taken in last 24 hours
Bleeding or active bleeding disorder
Pregnancy
Suspicion of thoracic or abdominal aortic aneurism
ASA is expired

Third, this is a trauma patient in my system. Patient over 65 on blood thinners with evidence of head injury + bleeding gets a trauma activation
 
Bullets said:
Couple of things

OP said the chest pain caused the fall. So that would be atraumatic pain. However, the contusion over her eye would be a contraindication based on NJ protocols:

Known hypersensitivity
325mg ASA taken in last 24 hours
Bleeding or active bleeding disorder
Pregnancy
Suspicion of thoracic or abdominal aortic aneurism
ASA is expired

Third, this is a trauma patient in my system. Patient over 65 on blood thinners with evidence of head injury + bleeding gets a trauma activation
Click to expand...

Very good points. i should of treated it as a trauma pt more then a chest pain pt. just to clarify pt was not bleeding though
 
Bullets said:
Patient over 65 on blood thinners with evidence of head injury + bleeding gets a trauma activation
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^ Exactly. And it doesn't take a genius to understand. Incidentally, what the pt says is but a fraction of what should be considered. Any assessment is MOI + Hx + evidence based, regardless of C/C. In this case, the MOI is a traumatic fall, based on medications the pt has Hx of cardiac-related issues (HTN + high cholesterol -> potential for atherosclerosis, ischemia, etc) and the evidence is in favour of a head trauma. What she's complaining about is relevant to a degree, but not in presence of an overwhelming traumatic evidence. Especially since she's stating a '10/10 chest pain' on her LEFT side, has a LEFT eye bruised and has normal vitals.

Bigbadwolf25 said:
just to clarify pt was not bleeding though
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I'm sorry, does your system provide you with X-ray eyes ?
 
ERDoc said:
But common sense should tell you that someone who potentially has a head bleed and is at an increased risk of a head bleed shouldn't get something that would make bleeding worse.
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Sure, but the way the protocols are written, you would be doing something wrong. It would be nice if they allowed you to use some common sense.

Qulevrius said:
Because that's way too much information for poor lil Basics. After all, why consider MOI plus underlying conditions such as age, Hx and existing medications if you can just do it by the book ?
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Could be. Don't mistake my statement for deferring to the protocol rather than using my head. My point is that its written poorly and in such a way that we aren't supposed to be using our heads.
 
W1IM said:
Could be. Don't mistake my statement for deferring to the protocol rather than using my head. My point is that its written poorly and in such a way that we aren't supposed to be using our heads.
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This is where I completely disagree. What's being taught in school and written in protocols are just guidelines for marginal scenarios, and have very little to do with everyday's reality. It's the same as adhering to a speed limit of 65 mph, regardless of road conditions and/or traffic situation, just because the signs say so. If healthcare providers don't use their heads, they're not just incompetent - they're dangerous.
 
Qulevrius said:
Because that's way too much information for poor lil Basics. After all, why consider MOI plus underlying conditions such as age, Hx and existing medications if you can just do it by the book ?
Click to expand...
I mean, I am pretty sure even the books would say this is a no no...
 
W1IM said:
Just a point of interest - after reading this thread and seeing the vehement opposition to ASA for a patient on blood thinners, I couldn't remember that being a contraindication in my state. I checked the MA protocols on ASA and found that the only contraindication listed is an active GI bleed.

So by the numbers, a patient on blood thinners with suspected cardiac related chest pain would get 324mg of aspirin, so long as they didn't have a GI Bleed. Sounds like we are an outlier here.
Click to expand...

Head bleed (or potential for same), though maybe not listed, is a contraindication to ASA as well.
 
Bigbadwolf25 said:
Very good points. i should of treated it as a trauma pt more then a chest pain pt. just to clarify pt was not bleeding though
Click to expand...

Bigbadwolf25 said:
had bruising swellong on her left eye
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Bruising = contusion
Contusion = hematoma
Hematoma = bleeding

If the fall imparted enough force to rupture blood vessels, do you know where that rupture stops?

http://geri-em.com/wp-content/uploa...alls-in-the-Elderly-from-EmergMedClin_413.pdf

http://www.beaumont.edu/press/news-...in-for-people-on-blood-thinners-saving-lives/
 
Bigbadwolf25 said:
Very good points. i should of treated it as a trauma pt more then a chest pain pt. just to clarify pt was not bleeding though
Click to expand...

Here is the problem. You are so protocol driven that you don't see the pt and only see the protocol. Most pts don't fit a nice, neat box. This isn't a chest pain pt and this isn't a trauma pt. It is a pt who has had ongoing chest pain who fell and hit her head and happens to be on blood thinners. Pts have multiple problems so you have to be able to think about your protocols and combine several of them to treat the pt.

I will agree with others, the medics are the real problem in this scenario.
 
ASA is an antiplatelet, not an anticoagulant. 324/325mg of ASA isn't going to kill this PT. If you loaded her up with UFH which is an actual anticoagulant I'd be concerned for bleeding but you didn't do that. Even if you gave her ASA + Clopidogrel you'd only be accomplishing dual antiplatelet which isn't the worst.
 
Alan L Serve said:
ASA is an antiplatelet, not an anticoagulant. 324/325mg of ASA isn't going to kill this PT. If you loaded her up with UFH which is an actual anticoagulant I'd be concerned for bleeding but you didn't do that. Even if you gave her ASA + Clopidogrel you'd only be accomplishing dual antiplatelet which isn't the worst.
Click to expand...

So are you saying that platelets aren't important for clotting?
 
Alan L Serve said:
ASA is an antiplatelet, not an anticoagulant. 324/325mg of ASA isn't going to kill this PT. If you loaded her up with UFH which is an actual anticoagulant I'd be concerned for bleeding but you didn't do that. Even if you gave her ASA + Clopidogrel you'd only be accomplishing dual antiplatelet which isn't the worst.
Click to expand...

Wait what?
 
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