Question has came up and need a little insight here. In an emergent setting of an elvolving MI, can you administer PO, chewable asa via rectally? Understanding the preferred administration is using a suppository, but should still have the same chemical properties after coating has been dizzolved. Thanks.
rectal administration of ASA
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VFlutter
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And how does either of those prevent platelet aggregation? Does anyone carry IV Integrilin?
Techincally it should work, maybe less effective, but I would not do it.
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MSDeltaFlt
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What scenario prompted this debate?
patient arrested. Successfully resus in ten minutes. Patient was intubated. induced hypothermia initiated. patient was showing positive neurological signs, ie eye tearing, lid flickering, extremitiy movement ect. patient sedated with fentanyl. successful. post arrest 12 and 15 leads obtained revealing an extensive MI. consulted with medical control, got orders for rectal administration of dissolvable aspirin. patient's doing well now. Just wondering what your guys thoughts are on it.
VFlutter
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I think at that point the hypothermia would be doing more for anticoagulation then the aspirin would.
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mycrofft
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Any use of a medication against its manufacturer's instructions is going to be outside your protocols. So-called "off label" use by MD's is being more and more frequently called into question.
You do realize the majority (are at least a large minority) of med use in EM is off-label right? Saying things like this just leads to groundless fears of litigation.
Why would you not do it? Is ASA really that much more crucial than Nitro and Fentanyl?
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VFlutter
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Yes, Yes it is. Aspirin has been proven to reduced morbidity and mortality in suspected MI. Nitro is a close second.
ASA is a core measure for AMI and must be administered by EMS or in the ER as well as prescribed on discharge. If not, no CMS payment.
Not trying to insult you but you do know that Aspirin is not used for pain, right?
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mycrofft
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Not groundless, although I hadn't considered that.
More like "Mycrofft, what were you thinking when you opened the aspirin bottle then put one tablet up the patient's rectum?".
Is rectal admin of oral ASA in anyone's protocols?
EDIT: No, that's not what "enteric coated: was SUPPOSED to mean.:blush:
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mycrofft
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Pharmacodynamically speaking
"The absorption of aspirin following rectal administration is slow and erratic. Oral administration is generally preferred. Because of the risk of mucosal damage, oral formulations of aspirin should never be administered by the rectal route."
PS: Mayo Clinic layperson education material (but noteworthy in its completeness)
http://www.mayoclinic.com/health/drug-information/DR602341/DSECTION=proper-use
"The absorption of aspirin following rectal administration is slow and erratic. Oral administration is generally preferred. Because of the risk of mucosal damage, oral formulations of aspirin should never be administered by the rectal route."
PS: Mayo Clinic layperson education material (but noteworthy in its completeness)
http://www.mayoclinic.com/health/drug-information/DR602341/DSECTION=proper-use
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Yes, we carry and will administer rectal ASA.
And to the poster questioning why: As Chase mentioned, ASA is one of the few treatments that has actually proven benefit. The verdict on nitro is still out. Opiates are actually quite questionable. There's evidence that shows them potentially harmful, though there's some debate on that aspect.
So yes, if rectal ASA is available to you, and applicable to the patient, give it.
We would all agree with that, but what im saying is in an emergent setting...if we could even slightly decrease the rate of morbidity or mortality; why not administer it? The patient was intubated, we all know aspirin is crucial. Chewable aspirin readily dizzolves. Mucosal wall damage is minimal due to the non-enteric coated in hand.
i do understand that concept yes
if i recall correctly, the only med that has the intended use for pain management is the fentanyl
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Nitro treats ischemic cardiac pain as well. That's not why we give it but a side effect of its mechanism is reduced discomfort for the pt...
There's a reason a lot of NTG drip guidelines have a starting point then say "titrate to pain level and SBP of xxx".
mycrofft
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But is your rectal ASA ordered for cardiac issues? Due to slow and erratic uptake?
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In potential cardiac-related CP or STEMI, and the patient is incapable of taking PO ASA, we will give PR ASA. It's not the preferred route, but it's preferred to not giving it.
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How do you prepare it for rectal administration?
I have never given aspirin rectally, but I am thinking 4 81mg tablets dissolved in 5cc NS, administered with a syringe rectally.
At any rate, while rectal administration of any medication tends to have erratic absorption, I would agree that at the onset of symptoms (cardiac arrest can be a symptom of ACS!) that the benefit of administration rectally outweighs the harm done by not giving it at all.
Chase, as for Integrilin, I am not sure how reasonable it is to begin administration prior to coags being drawn and evaluated. I have used it, and I know a few services that use it, but it was limited to interhospital critical care transfers, and we had access to current labs.
I am not aware of any 911 services that use, but I would be interested to know: 1.) do they exist & 2.) are labs drawn prior to administration?
I have never given aspirin rectally, but I am thinking 4 81mg tablets dissolved in 5cc NS, administered with a syringe rectally.
At any rate, while rectal administration of any medication tends to have erratic absorption, I would agree that at the onset of symptoms (cardiac arrest can be a symptom of ACS!) that the benefit of administration rectally outweighs the harm done by not giving it at all.
Chase, as for Integrilin, I am not sure how reasonable it is to begin administration prior to coags being drawn and evaluated. I have used it, and I know a few services that use it, but it was limited to interhospital critical care transfers, and we had access to current labs.
I am not aware of any 911 services that use, but I would be interested to know: 1.) do they exist & 2.) are labs drawn prior to administration?
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In regards to my above post...I was wondering about preparing it if you did not have ready made ASA suppositories (i.e. the physician asks you to administer it, and it is not routinely done in your service, and you don't stock suppositories.)