JakeEMTP Posted July 16, 2008 Share Posted July 16, 2008 . JakeEMT: you stated that you would not give it prior to the 12 lead; I have to ask, why? With it's delayed onset of action, and the pharmacokinetics of the drug, it will have no impact on your tracing (O2 may flatten out ST Elevation, sometimes) but ASA will not have any impact on the tracing. And remember that >50% of all MI patients rule in by enzyme markers in the hospital and have no ititial ECG changes. I would say, give the ASA, the 12 lead won't change... My 2 Cents..... How do I know his chest pain is cardiac related and not just acid reflux? I like to see what I'm dealing with. Delaying any interventions for 1 min isn't going to change things. Link to comment Share on other sites More sharing options...
saboats Posted July 16, 2008 Share Posted July 16, 2008 How do I know his chest pain is cardiac related and not just acid reflux? I like to see what I'm dealing with. Delaying any interventions for 1 min isn't going to change things. I agree that 1 min is going to change things, but... A neg, 12 lead means nothing, and they are neg, >50% of the time. Of course you would not give ASA to GERD however, as I stated, it's use is in Chest Pain of Suspected Cardiac Origin. If you rule out chest pain being of Cardiac Origin based on a neg 12 lead, then you (general, not picking a fight with you personally) need re-training on the pathophysiology and treatment of chest pain. Yes, a minute is ok, my point was you do not base your treatment on the 12 lead (when negative) so what's the point of delaying the only treatment proven to decrease M&M for it??? I live by the rule treat your patient not the monitor. You DO need to assess your patient 1st, and make the decision that the pain is of cardiac origin, then treat... I just don't agree that the 12 lead showed LEAD your treatment, but be an adjunctive tool in your assessment and treatment... Link to comment Share on other sites More sharing options...
chbare Posted July 16, 2008 Share Posted July 16, 2008 Hmm, I did not read that JakeEMT would not give ASA based on the 12 lead findings, I understand him as saying "I want to do a 12 lead first." Perhaps he considers assessment a priority? We do not start cramming interventions down our patients throats without a proper assessment. Is a 12 lead not part of a proper assessment? Take care, chbare. Link to comment Share on other sites More sharing options...
saboats Posted July 16, 2008 Share Posted July 16, 2008 Hmm, I did not read that JakeEMT would not give ASA based on the 12 lead findings, I understand him as saying "I want to do a 12 lead first." Perhaps he considers assessment a priority? We do not start cramming interventions down our patients throats without a proper assessment. Is a 12 lead not part of a proper assessment? Take caer, chbare. That isn't what I said... I believe I said... "You DO need to assess your patient 1st, and make the decision that the pain is of cardiac origin, then treat... " It appears that I stepped on someones ego. It was a simple disagreement about the steps. Yes you assess, and Yes a 12 lead is part of that assessment. I belive that is what I said. I just personally don't think you should delay ASA admin. by waiting until after the 12 lead. Your ongoing or secondary assessment is also part of your assessment, but you would begin Rx prior to this. I think this is some ALS Rules mentality. ASA is a simple BLS RX for chest pain of suspected Cardiac Etioligy. I personally don't care if you get the 12 lead then give the ASA. If you work in a system were you are in a medic interept vehicle, hopefully your BLS ambulance crew would have given the ASA before you get there. Are they wrong because a 12 lead wasn't aquired prior? Really, do it anyway you would like, the science, (eg, pharmacodynamics, pharmacokinetics of ASA, and the pathophysiology of Cardiac Chest pain) does not in anyway require a 12 lead before RX with ASA. That's all I was saying. I simply asked him "why" he would wait, he answered that question. chbare: I guess the answer to your question: "Perhaps he considers assessment a priority? We do not start cramming interventions down our patients throats without a proper assessment. Is a 12 lead not part of a proper assessment? is YES a 12 lead is absolutly part of a propor assessment...and early recognition and intervention is also. And if that point of the question was to try and point out that you can not do a propor assesment without a 12 lead, again I agree. I simply don't agree with waiting for a 12 lead to begin treatment. That's it..... Link to comment Share on other sites More sharing options...
saboats Posted July 16, 2008 Share Posted July 16, 2008 p.s., I am not trying to start a fight here. We are very aggressive with our treatment of AMI. eg, O2, 12/15 lead, MSO4 /Fent. ASA, NGT IVI, LMW Heprin, Plavix, GP2B3A Inhibitors, Beta Blockers, ect. As long as the treatment is given in a timely manner, that's all that matters. JakeEMT: if this was taken in anyway as an attack, I appoligize, that was not the intent. I was looking for reasons for Rx differences, and answer a questions posted to the group. Link to comment Share on other sites More sharing options...
chbare Posted July 16, 2008 Share Posted July 16, 2008 That isn't what I said... I believe I said... "You DO need to assess your patient 1st, and make the decision that the pain is of cardiac origin, then treat... " It appears that I stepped on someones ego. It was a simple disagreement about the steps. Yes you assess, and Yes a 12 lead is part of that assessment. I belive that is what I said. I just personally don't think you should delay ASA admin. by waiting until after the 12 lead. Your ongoing or secondary assessment is also part of your assessment, but you would begin Rx prior to this. I think this is some ALS Rules mentality. ASA is a simple BLS RX for chest pain of suspected Cardiac Etioligy. I personally don't care if you get the 12 lead then give the ASA. If you work in a system were you are in a medic interept vehicle, hopefully your BLS ambulance crew would have given the ASA before you get there. Are they wrong because a 12 lead wasn't aquired prior? Really, do it anyway you would like, the science, (eg, pharmacodynamics, pharmacokinetics of ASA, and the pathophysiology of Cardiac Chest pain) does not in anyway require a 12 lead before RX with ASA. That's all I was saying. I simply asked him "why" he would wait, he answered that question. chbare: I guess the answer to your question: "Perhaps he considers assessment a priority? We do not start cramming interventions down our patients throats without a proper assessment. Is a 12 lead not part of a proper assessment? is YES a 12 lead is absolutly part of a propor assessment...and early recognition and intervention is also. And if that point of the question was to try and point out that you can not do a propor assesment without a 12 lead, again I agree. I simply don't agree with waiting for a 12 lead to begin treatment. That's it..... Hey, it's all good. It comes down to what you think is a priority. Personally, I see no problem with getting the 12 lead first. I simply disagree with calling poopoo on somebody who would do the 12 lead first. Why not wait for the 12 lead? Is the ASA that much of a life saving intervention? Take care, chbare. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted July 17, 2008 Share Posted July 17, 2008 That isn't what I said... I believe I said... "You DO need to assess your patient 1st, and make the decision that the pain is of cardiac origin, then treat... " I do not see a problem with waiting for a 12 lead. We determined that part of a proper assessment includes a 12 lead ecg. The person calling for an MI is not going to hurt anymore if the aspirin is delayed another 5 minutes, to perform a thorough assessment. There is always the possibility that you find indications on the 12 lead that would rule out an MI. Most MI patients also call for EMS long after the MI has started, so another few minutes for Aspirin administration can wait for a proper assessment. Link to comment Share on other sites More sharing options...
jwraider Posted July 18, 2008 Author Share Posted July 18, 2008 Thanks guys. I think I have enough info to go on and make my own decision and build on it. I'm sure with experience I will be able to read the patient and incorporate treatments earlier and at the right time but for now I will do a full assessment first. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 18, 2008 Share Posted July 18, 2008 Thanks guys. I think I have enough info to go on and make my own decision and build on it. I'm sure with experience I will be able to read the patient and incorporate treatments earlier and at the right time but for now I will do a full assessment first. That's what we're here for. Any other questions, just ask. Link to comment Share on other sites More sharing options...
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