Nitro or aspirin first......?

[Ewok Jerky]

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.

 

[tpchristifulli]

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

Might not play into it at all if pulse ox is over 94%.

 

[Handsome Robb]

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.

 

[Handsome Robb]

+1 @beano.

On my phone so I can't "like" it.

 

[Byekryam]

Thanks everyone for the input, I appreciate it!

 

[ViolynEMT]

If you go by the registry exam, aspirin first because it works faster and is more reliable. Immediately keeps the platelets from aggregating further.

 

[teedubbyaw]

aspirin first because it works faster

No it doesn't.

 

[ViolynEMT]

No it doesn't.

I was quoting the registry explanation.

 

[teedubbyaw]

I was quoting the registry explanation.

Where?

 

[ViolynEMT]

Where?

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.

 

[DesertMedic66]

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.

Nitro has a very quick effect while aspirin can take ~30 minutes before it kicks in

 

[ViolynEMT]

Nitro has a very quick effect while aspirin can take ~30 minutes before it kicks in

My bad. Trying to delete my post but don't know how. Bad first day on the site for me.

 

[chaz90]

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.

Yeah, that's not correct.

 

[chaz90]

My bad. Trying to delete my post but don't know how. Bad first day on the site for me.

Didn't mean to pile on. No worries! The purpose of the site is to help people learn.

 

[teedubbyaw]

My bad. Trying to delete my post but don't know how. Bad first day on the site for me.

Don't worry about it. Should have seen me the other night on here.

 

[DesertMedic66]

Don't worry about it. Should have seen me the other night on here.

I have no clue what you're talking about...

 

[BFDM2]

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.

 

[gronch]

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.

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.

 

[JPINFV]

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.

Philosoraptor asks, "Is it possible to withhold something that isn't indicated?"

 

[DesertMedic66]

Philosoraptor asks, "Is it possible to withhold something that isn't indicated?"

Didn't take the time to make the meme this time?