BLS Aspirin Administration

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BLS Aspirin Administration

• Louisville Metro EMS
• for the
• Suburban Fire Districts LFR

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Objectives

• Verbalize the importance of early ASA
  administration in suspected MI.
• Identify patient circumstances where aspirin
  administration is indicated.
• Identify signs and symptoms of anaphylaxis
  secondary to aspirin administration.

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Myocardial Infarction Pathophysiology

• What is a heart attack or MI?
• Heart muscle injury death due to lack of
  oxygenated blood flow
• What causes an MI?
• Risk factors
• What are some of the complications of an MI?
• An MI or heart attack is not the same as a
  cardiac arrest
• Abnormal rhythm or heart-beat (v-tach or v-fib)
• Pump failure
• Hypotension or low blood pressure (cardiogenic
  shock)
• Heart failure/acute pulmonary edema

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Myocardial Infarction Incidence

• In the US, 1-1.5 million persons experience an
  acute MI each year.
• One-third of these individuals will die as a
  result of complications of their heart attack (lt
  500K).
• Approximately one-half of these deaths (lt250K)
  will occur out-of-hospital within the first hour
  of symptom onset.
• The quality of life for those who survive may be
  significantly diminished as a result of heart
  failure and other complications

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Treatment Benefits of aspirin

• Subsequent MIs are reduced by ¼.
• Deaths are reduced by 1/5.
• For every 15 patients with suspected AMI, who are
  treated promptly with ASA and rapid intervention,
  one early vascular death will be prevented.

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Anti-Platelet Pharmacology
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Pharmacokinetics

• Blocks pain impulses in the CNS
• Peripheral blood vessel dilator
• Fever Reducer
• Decreases platelet aggregation
• Atheromatous patches inside vessels allow
  platelets to aggregate.
• Aspirin decreases the stickiness of platelets
  by blocking thromboxane A2 which aggregates
  platelets and constricts arteries.

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Dosage

• 325 mg PO (chewed)
• (4) 81 mg Baby aspirin
• Avoid coated, enteric or time release
  preparations.

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Indications

• Anginal or ischemic type chest pain
• Anginal eqivalents (especially in the face of a
  high index of suspicion, or in the presence of
  cardiac risk factors for angina or MI (e.g., in
  diabetics or the elderly)
• SOA
• Weakness/dizziness
• Arm or back pain
• Nausea/vomiting

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Contraindications

• Trauma (ABSOLUTE)
• Aspirin Allergy (ABSOLUTE)
• GI bleeding (relative, unless actively bleeding)
• Active ulcer disease (relative)
• Hemorrhagic stroke/aneurism
• Bleeding disorders (relative)
• Children with flu-like symptoms

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Side Effects

• ALLERGIC REACTION
• Erythema/redness
• Urticaria/hives
• Airway swelling (difficulty breathing/stridor,
  drooling, change in voice)
• Hypotension, tachypnea, tachycardia
• Bronchospasm/wheezing
• Stomach irritation
• Heart burn or indigestion
• Nausea and vomiting
• Salicylism

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Drug Interactions

• Decreased effects with antacids and steroids
• Increased effects with anticoagulants, insulin,
  oral hypoglycemics and fibrinolytic agents.
• Different mechanism of action than other blood
  thinners, like coumadin.

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BLS Protocol for Chest Pain

• Patient history Indications for aspirin
• Chest pain
• Associated symptoms or anginal equivalent'
  symptoms
• Medical history risk factors or high-index of
  suspicion

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BLS Protocol for Chest Pain

• Patient history Indications for aspirin
• Pain quality, onset, duration, location,
  radiation, precipitating or aggravating factors,
  relieving factors, prior history of similar
  symptoms

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BLS Protocol for Chest Pain

• Patient history Indications for aspirin
• Associated symptoms or anginal equivalent'
  symptoms shortness of breath, nausea/vomiting,
  diaphoresis, palpitations, generalized weakness
  or dizziness (e.g., in diabetics)

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BLS Protocol for Chest Pain

• Patient history Indications for aspirin
• Medical history risk factors or high-index of
  suspicion prior history angina or MI,
  hypertension, smoking, high-cholesterol,
  diabetes, obesity, family history of angina or MI
  (immediate family members), male gender, age gt 60
• Medications Pay special attention to drugs for
  ED (Viagra, Cialis, Levitra)

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BLS Protocol for Chest Pain

• EXAM
• ABCs.
• Vital signs.
• General appearance uncomfortable, restless,
  apprehension, "feeling of impending doom".
• Skin pale, cool, clammy, cyanotic
• Chest lung sounds, rule-out trauma to the chest.

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BLS Protocol for Chest Pain

• TREATMENT
• Provide Initial Medical Care.
• Administer oxygen at 15 L/min. by NRB.
• Assist with ASA 325 mg (or 4x81 mg Chewed) PO,
  unless known allergy or contraindication.

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BLS Protocol for Chest Pain

• TREATMENT
• Under Direct/On-line Medical Control Order
• If the patient is awake, alert, and has SL
  Nitroglycerin (NTG) medication that has been
  prescribed by the patient's physician, assist the
  patient to take up to (3) SL Nitroglycerin at 5
  min intervals if chest pain is present and B/P gt
  100 Systolic

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BLS Protocol for Chest Pain

• TREATMENT
• Stop points for NTG administration include
• B/P drop below 100 Systolic stop NTG Treatment
  Protocol
• NTG not to exceed 3 doses within (1) hour
• Chest Pain is Relieved
• Do not give NTG for patients who have taken
  Viagra (Sildenafil), Cialis (tadalafil) or
  Levitra (vardenafil) in past 48 hours

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How to contact On-Line Medical Control for NTG
order

• Get Med Channel with UL
• Be Brief
• Identify yourself
• ASK FOR AN ORDER NUMBER
• Patient demographics (age, gender, etc.)
• Past medical history (prior angina or MI)
• History of present illness (chest pain or
  equivalent and associated symptoms)
• Physical exam (vitals, general appearance, skin)
• Patient treatment to present
• Your request
• Repeat the instructions given.

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Special Considerations

• Pregnancy Category D
• Doses higher than normal, may actually interfere
  with benefits.
• Give as soon as possible in suspected AMI

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