Quick Scenario For You (Students and New Medics)
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VentMonkey
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Again, as early stated, you certainly can, and would most likely not see any drastic changes in an normotensive RVI/ IWMI patient post-NTG administration, however, I would caution a cavalier approach to it is all (general statement here).
If anything, I'd be more inclined to be prepared to treat severe hypotension in a preload dependent MI.
If anything, I'd be more inclined to be prepared to treat severe hypotension in a preload dependent MI.
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VentMonkey
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Also, am I the only one who gets the feeling ASA's importance is often over looked, or even down played even in this day and age with prehospital providers?
Perhaps because it's a common OTC medication without any sexy sounding effects on the myocardium, and/ or coronary vasculature?
This is a bit of a random tangent I suppose, though.
NPO
Forum Deputy Chief
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No, I was just under the impression it wasn't a very immediately acting drug. I thought I heard it takes 24 hours to start taking effect.
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I don't think I have ever really seen a trend into it being down played. Folks I have worked with are usually pretty quick on getting ASA out.
VFlutter
Flight Nurse
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It actually is very quick acting. Around 12 mins.
http://www.health.harvard.edu/heart-health/aspirin-for-heart-attack-chew-or-swallow
VentMonkey
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Interesting, I've never heard this. Do you have any literature to back this?
Perhaps down played wasn't the right term, I just feel (IMHO), that's it's importance seems much more urgent in the layperson/ general population setting, and perhaps we (all prehospital folks) need to see it treated similarly in the face of an ACS/ AMI scenario.
It's effects (GI patients, and those allergic excluded) are so much less deleterious, and again, so much more important in these patients. Perhaps that's allz I meant
.Nail on the head, I think. ASA, like chest compressions, is not very sexy. People would rather nerd out about mixing mag. But since I suspect most people are still remembering to give it to suspected ACS patients, I'm not sure its importance being overlooked really hurts care. What do you think?
VentMonkey
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It depends on the individuals perspective. If it's still being delivered then I suppose it isn't that big a deal, but let's use your analogy here for a minute:
If (and it still isn't always performed with that sense of urgency) CPR isn't seen as cool as all the other nifty skills that are learned, and that go into a cardiac arrest at the paramedic level in spite of them proving time and time again that these skills add almost zero benefit in comparison to early defib and CPR, then clearly this proves our priorities, and knowledge base for our treatments are deserving of the pay wages that would reflect such, which more often than not, the less deserving providers gripe about.
Again, I can't say for sure what all else everyone thinks in regards to ASA over the other ACS meds, but when you still have people quoting "MONA" as a standard ACS algorithm, well, I can't help but wonder A) why bother to argue for higher wages?, B) how far off we still are from being considered professionals, and C) where or how others view aspirins superiority over the aforementioned in these patients.
I think the majority of folks on this forum pride themselves on forward thinking, and as trivial as ASA may seem, it's role has proven that even with the ever changing climate that is EBM, some things remain a constant for excellent reasons and shouldn't be taken for granted (again, ref. early def/ effective chest compressions). It's honestly just my $0.02 lol nothing more, nothing less.
FWIW, many of the people on this forum, and in this thread, are very much deserving of the professional title to me for obvious reasons.
VentMonkey
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And that was the point of my rant, lol. A "one-size fits all/ most" is just a bad habit to get into IMO, and can be lethal in some cases.
I get that many of these acronyms can help keep us on track, but knowing exactly when, or where to deviate, and then re-route is an extremely beneficial tool to have as a mental note. Much like you pointed out
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VentMonkey
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"FLONA"? (I'm more of a Fentanyl over MS guy personally, and the "L" referring to Labetalol). I would imagine you're talking about tachyarrhythmic prone MI's, such as apical's?
This is the study. I am trying to learn more about the when/why/how's of their use in MI's.
https://www.google.com/amp/s/coreem...anterior-stemi/amp/?client=ms-android-verizon