Asprin and nitroglycerin

[hylo]

Hi Guys

I am looking for some advice,studys, or general protocals concerning the use of asprin and nitro in the prehospital setting for MIs. The information I need concerns EMT-B personnel.
We are currently looking into the use of these drugs for EMTs in Dublin, Ireland.
We currently are staffed by EMT-Bs only and our protocals give us no access to drugs, we have just trained up our first six EMT-Ps in Boston, but until we get the change in legistation, we are trying to improve the quality of our caradic care and this is our first step, but we must justifiy it first.
As always your help will be invalauable.

Thanking you in advance,
Hylo
Stay safe guys.

[shedevil]

In our area, we are able to assist pt. with their own Rx of nitro if needed, but we(EMT-B), cannot give nitro or asa out of the drug box/bag. Our Medics , are able to give due to standing orders/protocal, or may do so with orders from attending MD.

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"For he shall give his angels charge over thee, to keep thee in all thy ways."
Psalm 92:11

[bob1350]

Our protocols say nothing about aspirin. An EMT-B can assist patient with nitro after contacting physician advisor. Protocols for nitro besides the usual blood pressure readings are: right patient(is this their prescription) right date(not expired) right route(under the tongue). Also our EMT's can carry the drug, just assist an alert patient

[miailer]

I am currently getting my paramedic thru a college degree program. In this region the local protocol has been changed to allow NTG and ASA to be given by EMT-B. In my Home Region, EMT-B can assist Pt own Rx of NTG and can't give NTG. Hopefuuly with the new American Heart Assoc. guidelines this will become more standardized.
Good luck and be safe.

[AMYEMT]

Greetings from sunny California. Out here, we do things differently (notice I didn't say "better"). Because of how sue-happy everybody is, EMT-Bs are allowed to only assist a pt with their own NTG if they are alert and able to administer it themselves. Medics can give out whatever they want (or, at least, what's on board). I went to a call at a Nursing Facility where a 60 y/o male was having crushing, radiating substernal chest pain and when I asked, the RN told me that TYL with codiene was given. I asked why no ASA was given and was told that the Rx wasn't on the MD orders. I asked around & found out that the RN was right, she cannot administer a non-perscribed medicine. So I guess that means that Medics are higher up on the chain of command?? I don't know, this whole state is screwy...Good Luck!

What doesn't kill us makes us stronger 8~}

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Expect the worst, hope for the best...

[Wabash Express]

Here in NC, an EMT-B can administer 325 mg. of ASA to the pt. in the cardiac setting. This is a standing order, and is allowed by the state. The EMT-B can also assist the pt. with taking their own nitro, only if the pt. is prescribed nitro, and if medical control gives permission.
Hope this helps you out.

Mike Clumpner
Firefighter/Paramedic
EMS Trainer
Durham City Fire Department

[jedge168]

Here in North Carolina it's also acceptable for the EMT-B's to assist the pt with his own meds. We as paramedics try to remind the basics that we work with that when they do this, esp with Asa, to make sure of what other rx they might be taking. Remembering that a pt on Coumadin doesn't need Asa. Good luck to you.

[whampus]

HERE IN CENTRAL IL.OUR LOCAL PROTOCOLS ALLOW US TO ADMINISTER NITRO AND/OR ASPRIN AFTER CONTACTING MED CONTROL,UNDER THERE ADVICE.WE ALSO CARRY EPI AUTO INJECTERS.WE ARE ALL B'S

[mark440]

Utah, a whole different playing field! An Emt-B in Utah as of January can assist with ASA. Emt-I's & P's can administer both NTG & ASA. Our dosage is the metered dose of NTG spray sublingual, and 160mg of Baby ASA PO. This Tx is not to exceed 1.2mg NTG (Metered dose is .4mg q 5 minutes, for max of 3 doses). This as an Emt-I is given in conguntion with a L.B. IV TKO, O2 @ 15LPM NRBM (O2 is a Emt-B skill as well). As for the RN unable to give meds, that is absolutely true! No Nurse (RN, LPN) can give ANYTHING w/o Rx, not even O2! But as long as the nurse has MD's approval of meds they may administer, they are invincible. Just remember to check other meds pt may be on, allergies, and if they have a NTG patch already. Most importantly VITALS !!!!

Where did the Epi-pen come into play at?

Mark

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If in doubt - Call us out

[This message has been edited by mark440 (edited September 07, 2000).]

[This message has been edited by mark440 (edited September 07, 2000).]

[N2DFire]

Well - I had wanted to reply to this for a while, but I wasn't sure what the BLS protocol was and I kept forgetting to bring my "Field Bible" (Protocol Book) to my "real" job.

Now - on to the answers.
BLS
2-4 81mg Baby Asprin AFTER ruling out Hx of GI Bleed or allergy

If Pt's BP is >100 Systolic AND WITH Med Control Orders - they can Administer the PT's Nitro. (BP to be rechecked prior to each nitro)

After 3 of Pt's Nitro (orders for each admin) they may use the Nitro from the Drug Box - Again only with orders from Med Control.


The ALS version is:
O2 High Flow
IV N.S. KVO
2-4 81mg ASA
Nitro Q 5 min - total of 3 doses (Provided BP >100 systolic)
MS 2mg over 2 Min Q 5 min to total of 10mg or until pain is relived or BP drops below 100 Systolic

Hope this helps you hylo - Best of luck in getting the legislation changes you need.

Take Care - Stay Safe
Stephen
FF/Paramedic

[HFDPOST321]

as far as our protocals are, we can assist the patient with their own Rx of nytro, but if we want to give a patient aspirin, we must do a med consult. it's all screwedup now, but oh well

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Deputy Chief James Ulrich
Hagerstown Fire Department Explorer Post 321

The opinions expressed here are my own and may not be those of my department.

[DCFyrMdc]

Hylo --

If you e-mail me I will be happy to send you our protocols -- we use both along with morphine.

Basically a chest pain call is O2 by mask, EKG, IV and then we give two baby aspirin (162 mg) and one 0.4 mg nitro tablet to chest pain patients. We also use the LifePak 12 so if I have significant ST segment changes in any of the v leads...I generally call Med Control for the morphine if the blood pressure is still steady.

Most of the surrounding communities seem to follow this pattern.

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Christopher Suprun
Firefighter/EMT-Cardiac
Dale City Vol Fire Dept.
www.dcvfd.org

[Lafd4me]

Dont forget to ask if they are useing Viagra before administering Nitro..Can be a deadly combination..so we are told here!! That is a must for us to ask that question and to have the proper vitals.As Emt-1D's we can assist them with administering their own Nitros her in LA.

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Tim..The FireGuy!!
LA City Fire Dept.