Nitro or aspirin first......?

In reality I don't think it matters which you do first because you will be administering both virtually "at the same time" so to speak...or at least <120 seconds.

In a theory though, I would say ASA first for a few reasons. #1 because it is the only 100% to be effective prehospital intervention for ACS/MI. #2 it has an onset of 30 minutes. #3 if you combine reasons 1 and 2 then logically ASA should be on board as soon as possible. #4 in general I think having a line before nitro is a good idea so why not get your ASA cranking while you start that line. #5 unless allergic, isn't almost any chest pain of cardiac origin getting ASA in the field? Based on a good HPI you can admin ASA before/while hooking up your 12 lead. Even with a clean 12 lead they are getting ASA anyways.
 
Ummm...NTG has been studied and shown no positive effect other than patient comfort.

Aspirin. Especially since it has a long onset, get it onboard.

At the end of the day it really doesn't matter.
 
+1 @beano.

On my phone so I can't "like" it.
 
If you go by the registry exam, aspirin first because it works faster and is more reliable. Immediately keeps the platelets from aggregating further.
 
ViolynEMT said:
Ugh. Aspirin or nitro first is one of the test prep questions on J and B. In the explanation for the answer is where it says that.
Click to expand...
Nitro has a very quick effect while aspirin can take ~30 minutes before it kicks in
 
ViolynEMT said:
My bad. Trying to delete my post but don't know how. Bad first day on the site for me.
Click to expand...
Didn't mean to pile on. No worries! The purpose of the site is to help people learn.
 
Well me personally when faced with a patient that is complain of chest pain I go with asprin first. I would withhold nitro until I have ran a 12 lead. This being for a couple of reasons. One to see if there is any kind of elevation in any of the leads and to rule out any right sided MI. While the leads are being placed on the pt they can be chewing the aspirin. Once 12 lead is done I would check for elevation and give nitro. So if there was elevation prior to nitro I can see if it has gone back down to base line after the administration of nitro. If it has not gone down I know to watch a little more closer and possibly choose a little morphine to help with pain and some dilation as well.

I would hate to give nitro prior to any 12 lead and there be elevation and it goes unseen. This would not help the pt in any way.

As far as oxygen I would with hold it if above 95%.I would choose a NC and tritrate it and keep it below 98-99%. It's hard to tell how much oxygen is actually in the blood once they reach the 100% mark. To much oxygen can cause vasocontriction of the blood vessels and cause more harm than good in the STEMI pt.
 
BFDM2 said:
Well me personally when faced with a patient that is complain of chest pain I go with asprin first. I would withhold nitro until I have ran a 12 lead. This being for a couple of reasons. One to see if there is any kind of elevation in any of the leads and to rule out any right sided MI. While the leads are being placed on the pt they can be chewing the aspirin. Once 12 lead is done I would check for elevation and give nitro. So if there was elevation prior to nitro I can see if it has gone back down to base line after the administration of nitro. If it has not gone down I know to watch a little more closer and possibly choose a little morphine to help with pain and some dilation as well.

I would hate to give nitro prior to any 12 lead and there be elevation and it goes unseen. This would not help the pt in any way.

As far as oxygen I would with hold it if above 95%.I would choose a NC and tritrate it and keep it below 98-99%. It's hard to tell how much oxygen is actually in the blood once they reach the 100% mark. To much oxygen can cause vasocontriction of the blood vessels and cause more harm than good in the STEMI pt.
Click to expand...


I think this is the right answer for all levels of care. For BLS, aspirin won't make your PT pass out, so put it first.
 
BFDM2 said:
As far as oxygen I would with hold it if above 95%.I would choose a NC and tritrate it and keep it below 98-99%. It's hard to tell how much oxygen is actually in the blood once they reach the 100% mark. To much oxygen can cause vasocontriction of the blood vessels and cause more harm than good in the STEMI pt.
Click to expand...

Philosoraptor asks, "Is it possible to withhold something that isn't indicated?"
 
JPINFV said:
Philosoraptor asks, "Is it possible to withhold something that isn't indicated?"
Click to expand...
Didn't take the time to make the meme this time?
 
You must log in or register to reply here.
Back
Top