ASA and AMI's, how much to give?

[lohof]

The Medical Director of the local private ambulance service has an MI protocol that includes administering three regular asprin tablets, (975 mg). I have heard of one regular or three baby aspirin, but never this much. Could everyone with ASA in a AMI protocol tell me how much you give, and if possible, what source you used to determine the amount to give. TIA

[N2DFire]

Well funny you should ask that. Our new protocol just went into effect first of this month. AMI & CP belived to be cardiac in origin get 2-4 baby asprin (81mg each) at provider discretion. Me personally - they only put 4 tabs in the drug box - seems a shame to break up a "family" may as well give em all. ;o)

Our protocols are written by a (sometimes too large) group of doctors who reference various sources including AHA ACLS guidelines.

If you'd like more detailed info on the new protocol, e-mail me and I'll give you a line by line from the protocol book.

Take Care - Stay Safe

Stephen

[chief4102]

iohof;
Our protocol is for 4 chewable baby asa, 81mg each. Too bad they don't come in "adult" flavors like pina colada or Budwiser.:-) That might make them easier to take!
Be Safe
Dan

[fyrmedik]

Our protocol for suspected AMI is 160 mg PO....Two baby ASA.

[Paramark14]

We give x2 81 mg chewable baby ASA PO to all non-trauma, suspected cardiac CP pts. JAMA has some good articles on onset and the prevention of platlet aggregation during AMI.

Mark
EMTP
Indiana

[lohof]

Ok, sounds like everyone is in the same ballpark. Has anyone read any research for the use of nearly 1000mg of ASA?? I just doesn't make sense to me. I wouldn't think that much is dangerous, but if there is no evidence for it, why risk it...

[FIREMEDIC BILL]

We give two baby asa, 81mg each, to every chest pain pt as related to cardiac. Furthermore, it is our protocol we give this even if pt is on asa every day or has already took asa PTA.

Be safe.

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FIREMEDIC BILL JENNINGS
GWINNETT FIRE/GRAYSON GA.
STATION 8-B SHIFT
ENGINE AND MED 8

[rlkaale]

This is an evolving topic in EMS and EDs where research continues on. The basics are believed that ASA benefits AMI patients through its ability to inhibit platelet aggregation. But in order to do this, ASA inhibits an enzyme called cyclooxygenase (COX), which governs platelet aggregation by making both thromboxane A2 (causes platelet aggregation) and prostacyclin (prevent platelet aggregation). So COX plays on both sides of the thrombosis fence, and researchers are still trying to figure out the magic dose. Remember, ASA is just one tool in the thrombosis/AMI treatment arsenal. The major heart organizations (Amer. Heart Assoc., Amer. College of Cariology, and Amer. College of Chest Physicians) generally recommend low-dose aspirin therapy (75-325 mg) as part of AMI treatment strategies. Complications of higher doses include GI bleeding and pain, asthma and bronchospasm. However, these are generally associated more with long-term therapy than one-time "back-of-the-ambulance" therapy. The recommended dose is a moving target, and I don't think I'd get too disturbed over being asked to administer a dose different than what others are doing.


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Rob Kaale
Med Student - UTMB
Licensed EMT-P (Tx)

[lohof]

But has anyone read a research article that shows a benefit from the three regular ASA? I don't mind seeing patients with big chalky-white mouths, I'm just looking for the research to back it up.

[spunk639]

Theremay be some data coming out in the fall on this. ACLS is being revamped and is due out in the fall. I believe one hospital in my area is doing a study on ASA administration, (BWH) but I'm not certain. This is a fairly new concept, I suppose we will see some study pro or con in the near future.

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REST IN PEACE
NEW YORK CITY EMERGENCY MEDICAL SERVICE

1869 - 1996

[Trauma_Dog]

We are a part of the TIMI 19 TRIALS (retavase). They want us to give 325mg before the retavase reguardless if they have taken asa today or not. Maybe after the trial is over maybe there will be disscusion on which dose is the best.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX

[GunghoEMTP]

We give 2-4 81mg chewable baby ASA for cardiac related chestpain. This protocol was created by our medical director which is based on current ACLS standards.

[emt_98]

Our protocol says to give 160mg ASA (2 81mg baby ASA) for chest pain and then give nitro if B/P is high enough(at least 100 mmHg systolic)

[Eric Bull]

In Nassau County, Long Island, NY, the ALS protocol is 325mg of chewed baby aspirin.

[Canmedic]

975mg of ASA strikes me as overkill. As everyone has stated, the reason for administration is to cause the inhibition of platelet aggregation; it has been determined that a dose of 160mg PO will cause this. Unless there's new research indicating 975mg works "better", I see no reason to give the pt more than is needed.

[Trauma_Dog]

I agree with Canmedic, 975mg seems to be over kill, particularly with the advent of other antiplatelet meds such as Reopro, Aggrestat and Integralin along with the use of Heprin.

In the 2000yr PDR has released a manual on thrombolyitic and antiplatelet therapy. I have read about the use of these medications, and it even includes asa, however I don't recall asa being Rx in that dose.

I would be interest on where there is information on this topic, so if you have it please let me know.

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Kent Simon
Paramedic Incharge
MCHD EMS,
Montgomery Co.,TX


[This message has been edited by Trauma_Dog (edited September 30, 2000).]

[This message has been edited by Trauma_Dog (edited September 30, 2000).]

[kmnader]

Right now we are giving 324mg of ASA as part of the TIMI 19 pre-hospital thrombolytic study.

Kris

[firejunkie99]

our protocol just changed from 2 baby asa to giving 4 baby asa. we are a county service, and our asa protocol is dictated by a city hospital that we are connected to.

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[22R1]

Protocols from Lakes Region General Hospital in central New Hampshire list 125-325 mg of chewable ASA as a Standing Order for Basic Level and higher for CP. The state sets what drugs and what dosages can be used pre-hospital by the various levels of certification. Hospitals can modify these down, but not up. Our hospital is progressive in pre-hospital treatment, so I would think that this the top state dosage.