broken stretcher
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ok maybe i was a little harsh, ill splint and if I'm in a good mood and you really could use it ill give you some O's while my partner straps you in to the stretcher
Medical interventions on scene
- Thread starter billycorgi
- Start date
OK almost sounds obscene lol.
How about epi pen? Albuteral inhaler assist? Bgl levels?
I will do about anything in the home if the person is really in distress. I would prefer to get to the ambulance if I need to
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How about hypoglycemic patients that turn into refusals 9/10 times? They're grouchy when woken up en-route to the hospital for a visit they don't need. If you're BLS, this still applies for oral glucose.
My understanding is that ASA is safe to give with pt's on blood thinners as a one time administration. What I've read (correct me if I'm wrong) is that the ASA causes the Cuomadin (or other blood thinner) to become unbound and cause massive decrease in your pt's coagulability. Pt's on blood thinners are told not to take ASA for this reason but during a cardiac event my understanding is that this is a safe tx. Thoughts?
Matt
abckidsmom
Dances with Patients
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Aspiring makes the platelets less sticky. Less sticky platelets make clots less likely to form in areas with limited flow (like blocked coronary arteries). Platelets are the first step in a long, complex cascade of events that lead to a strong clot.
Coumadin blocks another step, much further down that cascade.
Patients on blood thinners with a high risk of coronary artery blockage aren't typically told not to take aspirin. It's really personally driven, knowing that aspirin is a major preventer of clot formation in coronary arteries.
If a person is on blood thinners already and has not already taken aspirin , I will call ahead if it is a longer transport. We are within 3 minutes usually, but I have given it before. Its just some thing I was taught.
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That is interesting. Do you have a reference?
Warfarin and aspirin are both highly protein bound (>95%, IIRC), so if aspirin were to have a much greater affinity for the plasma protein binding sites than does warfarin, the bound warfarin would be displaced from the proteins, the free fraction of drug would be increased, and the net result would essentially be the same as giving a large bolus of warfarin.
That said, I've never heard of warfarin being an absolute contraindication to aspirin, and I've always assumed that the danger of co-administration was related more to syngergistic anticoagulant effects than any direct or indirect interaction between the drugs.
My paramedic instructor mentioned this, one of the many things that I have no idea how she knows without having an MD... her lectures would go along the lines of "if the atmospheric pressure of Oxygen is 20.95%..." anyhow after some digging here's an article I came up with
"Medications such as aspirin and the NSAIDs, and high doses of penicillin and moxalactam can increase the risk of warfarin related bleeding by inhibiting platelet function. Aspirin posses the most significant risk due to its common use and its prolonged effect on platelets. The proposed mechanism of interaction involves the possibility that salicylates displace warfarin from plasma protein-binding sites. However, the transient nature of the interaction make the significance of this mechanism questionable as compared to aspirin's intrinsic effect on platelets. Aspirin and NSAIDs can also produce gastric erosions that increase the risk of serious upper gastrointestinal bleeding. Some of the available NSAIDs may have a lesser effect on coagulation than aspirin."
https://secure.pharmacytimes.com/lessons/200301-01.asp
Seems that the ASA has a higher affinity and displaces the Cuomadin, so in effect you are 'giving your pt' a bolus of anticoagulant AND causing the inhibitory A2 thromboxane effects intrinsic in the ASA... just how I remember it, think it might hold some merit?
Matt
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Well, I'm no pharmacist myself, so I just go by what I read. It sounds from this like the displacement of warfarin is a transient and likely minor effect. I have to review anticoagulants over the next couple weeks so I'll keep this in mind and see if I come across anything about it in my texts.
Good find.
Christopher
Forum Deputy Chief
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I'll add Dr. John Mandrola's take on this (if you don't read his stuff, it'd be worth checking out):
This isn't a peer review article, but a practical look at the clinical implication of ASA + anticoagulants (both classical and novel).DrJohnM said:
unleashedfury
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On Topic.
Its a variable situation. If the patient appears to be in little to no distress. They can wait to get to the buggy. If they are in need of immidiate life saving interventions based on my primary assesment. Its do what we can to get them stable, and roll. OTOH there are things that was mentioned earlier that can be non life threatening and beneficial. I.E. splinting a broken extremitiy before movement, using a antiemetic for the nauseated pt.
Its really a situation based question. where some would say meh you got time do your thing here. Others will say lets just get rolling we'll get what we can along the way. My transport times at my primary service is about 5 minutes from most locations. So to spend a tremondous amount of time on scene is not for me. My general theory is what can't be done here the hospital can get done there. So usually I do a quick assesment triage my patient on scene. and go, as far as 12 lead monitoring goes. Yes its better to get a good capture in a house or parked outside before rolling to avoid excessive artifiact.
So the the OP. if your still new, develop your own rapport and run with it. it comes down to what makes you most comfortable, without causing damage or fear to your patient.
Its a variable situation. If the patient appears to be in little to no distress. They can wait to get to the buggy. If they are in need of immidiate life saving interventions based on my primary assesment. Its do what we can to get them stable, and roll. OTOH there are things that was mentioned earlier that can be non life threatening and beneficial. I.E. splinting a broken extremitiy before movement, using a antiemetic for the nauseated pt.
Its really a situation based question. where some would say meh you got time do your thing here. Others will say lets just get rolling we'll get what we can along the way. My transport times at my primary service is about 5 minutes from most locations. So to spend a tremondous amount of time on scene is not for me. My general theory is what can't be done here the hospital can get done there. So usually I do a quick assesment triage my patient on scene. and go, as far as 12 lead monitoring goes. Yes its better to get a good capture in a house or parked outside before rolling to avoid excessive artifiact.
So the the OP. if your still new, develop your own rapport and run with it. it comes down to what makes you most comfortable, without causing damage or fear to your patient.