Nitro or aspirin first......?

Byekryam

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My question......potential MI, nitro or aspirin first?

Thought pattern.....give nitro first because can start working, then give pt aspirin to start chewing. If you give aspirin first, you have to wait till they chew first till you can administer nitro (not really, but usually)

Other thought pattern....ASA gets absorbed slower then nitro through mucosal membranes, so get nitro on board so can open up vessels.

Other thought pattern.....give ASA to chew, then spray nitro on top of tongue (as per instructions on side of nitro box)

Other thought patterns..........? (I'm open to thoughts)

I'm researching literature which suggests one is the proper route to administer these medications. Does anyone know the proper sequence, and is there any documentation (literature) to back it up.

This may seem silly to argue over, but I would like to know.

Thanks
 

DesertMedic66

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I've never seen it done one way over the other. In the time frame it takes for ASA to be chewed or NTG to dissolve I don't think it makes any difference.
 

STXmedic

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Who cares? Give both. 60 seconds isn't going to make a difference either way.
 
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Byekryam

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I am a relatively new medic and have, in the past, been chastised for doing one over the other. Trying to now help other "newer" medic students (and not chastising them), I am trying to guide them in the right ways to do things, but today was sternly disciplined for saying the wrong thing (the thing I was taught). I just want to make sure I'm teaching the right procedure, that's all......
 

Akulahawk

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I usually give first whichever one is closest to grab. Usually it's NTG SL 0.4 mg (spray) and ASA 162-324 mg (per protocol) in that order. No real preference, just my bags were set up so the NTG was easiest to grab.
 
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Byekryam

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Lots of great input, I appreciate it. Yes, this is in light of the 12 lead, and is in the consideration of the pressure. If someone was borderline, I would certainly go with the line first/nitro second mindset. But this is in the pressence of an elevated BP where either the IV is already established or they are so hypertensive, that it's going to be rare that they are going to tank on one spray.
 

azbrewcrew

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Truthfully i dont think there's a right or wrong answer to your question. As long as you operate within your protocols and document your treatments you should be fine. Every medic has their own way of doing things. Some areas require iv access prior to admin nitro, some don't. If its a hypertensive crisis situation i dont see why giving nitro without an iv would be an issue
 

tpchristifulli

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Lots of great input, I appreciate it. Yes, this is in light of the 12 lead, and is in the consideration of the pressure. If someone was borderline, I would certainly go with the line first/nitro second mindset. But this is in the pressence of an elevated BP where either the IV is already established or they are so hypertensive, that it's going to be rare that they are going to tank on one spray.
What do you mean " In light of the 12 lead"?
 

avdrummerboy

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Realistically, it doesn't matter, you're going to give both pending any reason to withhold one or the other anyway, and you're going to administer both at the same time, what possible difference can it make, they will both be entering the body at the same time, sure PO can take a little longer to ingest, but you're not going to waste time waiting for it to take effect before admin of NTG. Unless there is a protocol explicitly stating to do it one way or the other, just give both in whatever order you please.
 

fma08

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What was the reasoning of doing one over the other first? I'm calling bogus (without literature to back this up, don't judge). Two different drugs, two different MOAs acting on two different aspects of the disease process, there's no reason that one would need to be given first. If anything, give them aspirin to chew up so that they can work on that while you're getting your IV, and 12 lead, and BP, etc.
 

Burritomedic1127

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ASA is the key. A great instructor told me a while back, ASA is like a bouncer its doesn't break up the party, it just stops more people from showing up
 

JPINFV

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People really care about which is given first? Where does oxygen play into this?
 

DesertMedic66

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People really care about which is given first? Where does oxygen play into this?
Clearly you put the pt on a NRB while they are chewing the ASA so the O2 pushes the powder into their lungs for a much faster response #don'tjudgeme
 

Akulahawk

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People really care about which is given first? Where does oxygen play into this?
Hopefully the patient is still breathing?
 

Carlos Danger

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I usually give the aspirin first and wait till after my 12 lead to give Nitro... Gotta watch for that hidden Right Sided involvement. Plus you should have a line before you give nitro. ASA first IMO.

People take NTG all the time without taking their VS first and when no one is around to start an IV. BLS also administers it in some places, without getting an EKG first.

Also, the evidence does not appear supportive of the idea that right-sided involvement tends to result in significantly greater rates of hypotension.
 
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Byekryam

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"In light of the 12 lead" meaning being aware of a pre-load issue where it would be contra indicated.

I did actually read one article from a cardiac institute which was written recently which did state that there is clear evidence that the ASA makes a difinitive difference, while it's only speculative on the actual benefits of the nitro.
 

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