Nitro before IV
- Thread starter FFMedic1911
- Start date
I'm sorry, but this descrption defies belief.
Makes blood slippery?
Helps flow through the narrowing artery by being slippery?
ASA contraindicated with "blood thinner?" I think this is too simplistic to be true.
Heparin of minor benefit? Maybe not as aggresive as tpa or streptokinase, but minor?
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Isn't ASA a 'platelet agitator'? Specifically classed as an Anticoagulant, NSAID, antipyretic, and analgesic... I could see how slippery could be used to define the action...but not really.
emtchick171
Forum Lieutenant
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I'm slightly confused on this one. Nitro is a nitrate...thus being said the production of energy requires oxygen. Angina or "heart pain" is due to an inadequate flow of oxygenated blood to the muscle of the heart. It is believed that all nitrates, including nitroglycerin, correct the imbalance between the flow of blood and oxygen to the heart and the work that the heart must do by dilating the arteries & veins in the body. Dilation of the veins reduces the amount of blood returning to the heart so that the heart does less work and requires less blood and oxygen.
^^or at least that's what we have been taught in every class I've ever taken.
emtchick171
Forum Lieutenant
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I agree with you. It is a platelet aggregate, anticoagulant, analgesic...etc.
Also, I will occasionally give ASA as a first option for chest pains, however...I generally just go straight for the nitro, especially if they have a history of angina...providing that their blood pressure is high enough to administer Nitro.
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JPINFV
Gadfly
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Considering that the MOA and reason for giving ASA and nitro are completely different, why are you withholding ASA due to nitro? ASA is not given in ACS for pain control.
emtchick171
Forum Lieutenant
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It is not that I am withholding ASA because of nitro...but in our county protocols...it is completely up to our discretion whether we administer 160-324mg of ASA and then give nitro, or we can just go straight for nitro. It all depends on the situation and how my patient is reacting to the drugs I administer, and the treatment given.
JPINFV
Gadfly
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Just curious, then, if the chest pain responds to nitroglycern and the pain level decreases, do you not administer ASA because the patient responded positively?
emtchick171
Forum Lieutenant
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It has a lot to do with the patient's history, and their current medical/physical condition.
vquintessence
Forum Captain
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You'd make a fine politician; you successfully dodged his question while providing an answer!
emtchick171
Forum Lieutenant
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You'd make a fine politician; you successfully dodged his question while providing an answer!
Am I supposed to take this as a compliment or an insult??? hahahaha
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It makes sense to go straight to the nitro because of its fast action. I like to give the ASA then the nitro to give the ASA a head start on kicking in since by the time the nitro wears off the ASA will be kicking in.
emtchick171
Forum Lieutenant
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I'm glad to see that someone else agrees with me! My goal is to get my patient the best quality care, and to get the quickest pain relief.
JPINFV
Gadfly
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May I put forth that there's a difference between the order interventions are given and potentially withholding ASA because the patient responded to treatment with nitro?
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True. But just as I said short action vs. long action. NTG lasts 4-5 minutes x 3 doses thats 12 minutes of relief whereas ASA lasts much longer, but takes longer to set in.
I know medics that will push a little fent and then add some morphine on top because of the same reason, short action vs. long action.
I know medics that will push a little fent and then add some morphine on top because of the same reason, short action vs. long action.
18G
Paramedic
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It appears there is some misconception about the MOA and importance of timely administration of ASA in ACS/MI.
ASA is not a "platelet aggregate". Platelet aggregation is what we do NOT want to have happen as it will worsen the blockage. ASA prevents platelet aggregation by blocking the enzyme COX (cyclooxygenase) which in turn inhibits the synthesis of thromboxane A2 which is what stimulates platelet activity and their aggregation. Stating that ASA makes platelets slippery is somewhat accurate albeit an elementary description.
ASA can also cause some arterial vasodilation through blockage of prostaglandins.
The earlier the aspirin is administered the better for the patient. Some 911 centers through EMD instruct callers to admin ASA prior to EMS because of the importance of early administration.
Aspirin is classified as an anti-platelet agent in addition to the several others.
I would give ASA as early as possible and before NTG... ASA has been shown to reduce patient death, NTG has not.
the_negro_puppy
Forum Asst. Chief
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Our protocosl state to give GTN before aspirin h34r:
h34r:
18G
Paramedic
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Our protocol has ASA before NTG
JPINFV
Gadfly
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I highly doubt that it matters whether NTG or ASA goes first provided the patient gets ASA at some point early in the course.