aspirin administration for ems
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Aspirin Administration by
EMT-B’s
January 2015
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The Heart
Four Chamber Pump
Blood fed into RA
From RV to Lungs
Back to LA
To Body from LV through Aorta
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Pathology of Cardiac Events
Atherosclerosis Thrombus/Emboli Trauma Spasm Low/No Oxygen
◦ Anemia ◦ Hypotension ◦ Drugs/toxins (CO, cocaine, opiates, cyanide) ◦ Hypoxia
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Risk Factors…
Hypertension
Diabetes
High Cholesterol
Immediate Family History
Smoking
Sex: Males > Females
Cocaine Use
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Angina
Pathophysiology ◦ Ischemia of heart muscle due to inadequate oxygen supply
Causes may include partial occlusion, spasm, hypotension and anemia
◦ Transient in nature
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Angina
Stable: Onset during physical activity, lasting 3 to 5 minutes, relief with rest or self administered nitrates.
Unstable: Onset at rest, occurring more frequently, lasting > 5 minutes, resistant to nitrates.
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Angina
Signs and Symptoms: ◦ Chest Pain/ Pressure
◦ Dyspnea
◦ Diaphoresis
◦ History is Essential
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Angina
Treatment ◦ Oxygen
◦ Minimize physical activity
◦ Position of comfort
◦ Paramedic (even if symptoms resolve)
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Acute Coronary Syndrome / Myocardial Infarction
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ACS / Myocardial Infarction Pathophysiology
◦ Death of heart muscle due to inadequate oxygen supply (“infarct”) Causes may include occlusion, spasm, micro
emboli, acute volume overload, hypotension, acute respiratory failure, and trauma.
◦ Location and size dependent on the specific coronary artery involved.
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ACS / Myocardial Infarction
◦ Effects of a Myocardial Infarction
Dysrhythmias
Heart Failure
Ventricular Aneurysm
◦ Goals of Treatment
Pain Relief
Reperfusion (The restoration of blood flow to an organ or tissue )
TIME = MUSCLE
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ACS / Myocardial Infarction
Field Assessment ◦ Airway
◦ Breathing
◦ Signs of Shock
◦ Chief Complaint Typically related to chest pain.
Evaluate using OPQRST: ◦ Discomfort > 30 minutes.
◦ Radiation to arms, neck, back, or epigastric region.
Patients may minimize symptoms.
Feelings of “impending doom.”
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Items of Immediate Assessment (<10 min)
Check vital signs (HR, RR, BP, skin)
Determine oxygen saturation
Obtain a history (SAMPLE) and perform a focused physical examination (including OPQRST)
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Immediate General Treatment
Oxygen via NRB at 15 l/min
Aspirin 324 mg
Nitroglycerin SL or spray
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Aspirin: Actions
Why? (Actions) ◦ Inhibits platelet aggregation (stops platelets
from sticking together)
This action will reduce: ◦ Overall mortality from AMI
◦ Nonfatal reinfarction
◦ Nonfatal stroke
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Aspirin: Indications, Dose, Precautions
When? (Indications) As soon as possible! ◦ Standard therapy for all patients with new pain suggestive
of AMI
◦ Give within minutes of arrival
How? (Dose) 324-mg (4 tablets) taken as soon as possible
Watch Out! (Precautions) ◦ Relatively contraindicated in patients with active peptic
ulcer disease or asthma
◦ Contraindicated in patients with known aspirin hypersensitivity
◦ Bleeding disorders
◦ Severe hepatic disease
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ASPIRIN Generic Name: Aspirin Trade Names: Acetylsalicylic acid®,
Bayer®, Aspirin, Anacin®, Ecotrin®, Bufferin®, and many more…
Mechanism of Action: Inhibits platelet aggregation thereby
decreases blood clotting time Anti-inflammatory effects Reduces fever Analgesic effects Indications: Cardiac chest pain to decrease
incidence of heart attack
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CT Regional EMS Guidelines
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CT Regional EMS Guidelines