You realize how much anxiety your going to add to your patient when transporting code 3 therefore increasing their BP, HR and myocardial oxygen demand? Bad call.
Analgesics are humane, we don't give them to reduce anxiety, we give them to reduce pain. Your correct in the fact that reduced pain reduces anxiety, I'll give you that.
Aspirin does not help re-perfuse, it is a platelet aggregator, preventing the clot from becoming larger, it does nothing to break the clot and return perfusion to the ischemic tissue.
Yea NTG might dilate the vessels, but that clot is just going to move through the dilated vessels only to get caught again as the vessels decrease in size. (Remember Arteries -> arterioles -> capillaries?) NTG does nothing to break the clot up.
Morphine reduces pain, therefore reducing anxiety while also reducing preload by reducing venous return thus lowering the workload on the heart and myocardial oxygen demand.
ACS is not a BLS call, can you interpret a 12 lead? STEMI alerts activated by ALS providers after reviewing a 12 lead in the field reduce door to cath-lab time and increase survivability and quality of life in ACS patients post-discharge from the hospital.
Hyper-oxygenation constricts coronary vessels, it's a proven fact. Yea there's a high PaO2, but if the vessels are constricted then the blood with the high PaO2 can't get to the tissue what good does that do? Do some more continuing education other than the bare minimum.
This is coming from a fellow Intermediate.
A. I would kill a driver who drove like an idiot with any pt. I do not advocate that kind of transport. However i am completely honest with my pts, they know somethings wrong and by telling them the truth it takes away from the anxiety of "not knowing".
B. You are correct in that aspirin does not dissolve a clot, however, aspirin is listed as a primary initial step under reperfusion therapy in both ACS and Ischemic stroke. In the future i will be more precise with my words.
C. When it comes to NTG, i said nothing about clot busting, it vasodialates, and even if the clot moves, we now have the chance of it moving to a more branched vessel, decreasing the area of injury/ischemia.
D. I agree with your morphine statement, 100%, i do not like the terming of humane, we treat people because they deserve the treatment, not because we feel pity for them as the word humane would suggest.
E. Im not saying ACS should be a BLS, it was in response to an earlier statement that aspirin and trans was the only things we can do for these pts. As far as im concerned, if dispatchers (in our area) can advise pt.s to take aspirin prior to our arrival, a BLS provider should be able to. There are far more things we can do for these pt.s to improve their chances of survival. Yes, i can interpret a 12 lead, not as well as id like to be able to, but well enough to be effective.
F. No, hyper oxyenation is not a "proven", nor "disproven" fact. Certain agencies support and others refute. That is completely up to the providers and the service area. This can go on and on involving the dispute of pulse oximeters, remembering that pulse ox's determine the % of hemoglobin saturated with something, may not always be oxygen. And even in the studies that support the ill effects of hyperoxygenation, they are quick to point out that the potential positive effects of supplemental oxygen at low concentrations out weigh the potential ill effects of this therapy.
Please do not question my education level without knowing, nor speaking with me. I dont not claim to know half of what most people in this forum do. I do however, take the extra steps, take the extra classes, read the articles and studies and do my research.
Granted, I don't like 88%, but that's not the question 
