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In this lesson, we'll go over the medication aspirin, or ASA, and all of its effects, including indications, precautions and contraindications, and pediatric dosages. At the end of the lesson, you'll find a Word about vasopressors.
Aspirin blocks the formation of Thromboxane A2, thus inhibiting the sticking together of platelets and thus also reducing clot formation. The use of aspirin for myocardial infarctions helps reduce the chances of death and also the probability of reinfarction in stroke victims.
Aspirin Indications
The use of aspirin is indicated in the presence of signs and symptoms of acute coronary syndromes (ACS) such as those patients suffering from:
- Chest pain
- Chest pressure
- Discomfort, like pain radiating into the neck, jaw or down either arm
Another reason for administering aspirin is when there are ECG changes that are consistent with acute coronary syndromes. A few examples of this would include, but are not limited to, ST elevation, depression, or T-wave inversion.
Aspirin Precautions and Contraindications
Now let's look at some aspirin precautions and contraindications.
Before administering aspirin, be sure to ask the patient if he or she has any known hypersensitivities like Samter's Triad. This is a serious condition that can lead to a serious reaction when those patients are given aspirin.
Pro Tip #1: Samter's Triad is a chronic condition defined by asthma, sinus inflammation with recurring nasal polyps, and aspirin sensitivity. It's also called aspirin-exacerbated respiratory disease (AERD), or ASA triad.
You will also need to know, before giving a patient aspirin, if they have any bleeding disorders, like hemophilia, active ulcer disease, or recent gastrointestinal bleeding.
Also, take heed of the Pro Tip above and ask the patient if he or she has a severe allergy like anaphylaxis or asthma-related to aspirin, as compared to more moderate sensitivities like sneezing or stuffiness.
Adult Dosage of Aspirin
A proper adult aspirin dose is 2 to 4 chewable aspirins or 162 to 324 mg of non-enteric coated aspirin as soon as possible following the onset of symptoms.
Aspirin suppositories – usually in a 300 mg dosage – are also a safe alternative if the patient has any severe nausea, vomiting, or gastrointestinal disorders.
Pro Tip #2: It's important to note, that in order to achieve a rapid therapeutic blood level of aspirin, you should instruct the patient to chew the oral aspirin before swallowing.
A Word About Vasopressors
While there is evidence that the use of vasopressors favors initial resuscitation with ROSC, research is still lacking on the effect of the routine use of vasopressors at any stage during the management of cardiac arrest on the rates of survival to hospital discharge.
Vasopressors Used During Cardiac Arrest
Vasopressors optimize cardiac output and blood pressure. The vasopressor used during cardiac arrest is: Epinephrine – 1 mg delivered IV or IO and repeated every 3 to 5 minutes.
If IV or IO access cannot be established or for some reason is delayed, instead give epinephrine 2 to 2.5 mg diluted in 5 to 10 ml of sterile water or normal saline and injected directly into the patient's endotracheal tube.
It's important to remember that the endotracheal route of drug administration results in variable and unpredictable drug absorption and blood levels.
Epinephrine
Although healthcare providers have used epinephrine for years during resuscitation, there haven't been many studies conducted to address the question of whether it improves outcomes in human patients.
Epinephrine administration improves the return of spontaneous circulation as well as hospital admission rates. However, large studies have not been conducted to evaluate whether survival is actually improved.
Because there haven't been any large studies to confirm long-term patient outcomes, we must rely on the positive short-term effects of increased return of spontaneous circulation and the increased hospital admission to support the use of epinephrine in cardiac arrest cases.
No studies demonstrate improved rates of survival to hospital discharge or neurologic outcome when comparing standard epinephrine doses with initial high-dose or escalating-dose epinephrine. Therefore, the American Heart Association does not recommend the routine use of high-dose or escalating doses of epinephrine.
Epinephrine is believed to:
- Stimulate adrenergic receptors
- Produce vasoconstriction
- Increase blood pressure and heart rate
- Improve perfusion pressure to the brain and heart
Repeat epinephrine doses of 1 mg via IV or IO every 3 to 5 minutes during cardiac arrest.
Remember, follow each dose given by peripheral injection with a 20 ml flush of IV fluid and elevate the extremity above the level of the heart for 10 to 20 seconds.
