Aspirin Administration by

EMT-B’s

January 2015

The Heart

Four Chamber Pump

Blood fed into RA

From RV to Lungs

Back to LA

To Body from LV through Aorta

Pathology of Cardiac Events

Atherosclerosis Thrombus/Emboli Trauma Spasm Low/No Oxygen

◦ Anemia ◦ Hypotension ◦ Drugs/toxins (CO, cocaine, opiates, cyanide) ◦ Hypoxia

Risk Factors…

Hypertension

Diabetes

High Cholesterol

Immediate Family History

Smoking

Sex: Males > Females

Cocaine Use

Angina

Pathophysiology ◦ Ischemia of heart muscle due to inadequate oxygen supply

Causes may include partial occlusion, spasm, hypotension and anemia

◦ Transient in nature

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.

Angina

Signs and Symptoms: ◦ Chest Pain/ Pressure

◦ Dyspnea

◦ Diaphoresis

◦ History is Essential

Angina

Treatment ◦ Oxygen

◦ Minimize physical activity

◦ Position of comfort

◦ Paramedic (even if symptoms resolve)

Acute Coronary Syndrome / Myocardial Infarction

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.

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

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.”

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)

Immediate General Treatment

Oxygen via NRB at 15 l/min

Aspirin 324 mg

Nitroglycerin SL or spray

Aspirin: Actions

Why? (Actions) ◦ Inhibits platelet aggregation (stops platelets

from sticking together)

This action will reduce: ◦ Overall mortality from AMI

◦ Nonfatal reinfarction

◦ Nonfatal stroke

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

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

CT Regional EMS Guidelines

CT Regional EMS Guidelines