ASA Contraindications

[robertsdvd]

It came up today, I'm in MA and "practice" as a Basic. It was drilled into me that there were certain contraindications to administering ASA for ischemic CP. 1) Allergy or "Hypersensitivity" 2) Pregnancy 3) Recent GI Bleed 4) Recent Trauma/Surgery 5) Currently on Anti-coagulation therapy. These I got from EMT school and EMS academy, I just checked all my notes and books and all say essentially the same thing.

An ALS coordinator said the only contra- was an allergy. We checked the back of the protocol book and it said "Hypersensitivity" and GI Bleed and a caution towards using it on women who are pregnant.

So, I asked around our BLS population and seemed to get an idea, these are Basics from different schools and different regions - and what came clear was that anyone who has been a Basic for maybe less than 5 years considers whether or not the pt. is on some sort of anti-coagulation therapy and considers it a contraindication - whereas providers who have been longer than 5 years on seem to say the only contra- is the allergy and give it.

Any comments? Discussion? Trying to figure out the rift and, if indeed, these are not contraindications, why they're being taught as such at different schools.

[ERDoc]

As always it is a risk vs benefit situation. Allergy is a definite contraindication. I don't have a problem giving it to someone who is anticoagulated. As far as the GI bleed, it depends on the severity. I would be more concerned with giving heparin than asa. As far as trauma and surgery it depends on the situation. Pregnant pts are often given ASA during their pregnancies if they have a hypercoagulable issue.

[mrmeaner]

I agree that most things are relative, especially "allergies". I just had a pt. who listed Lipitor as an allergy because it gives her gas. Another pt. told my instructor that she was allergic to epinephrine because it makes her heart race.

[spenac]

I agree that most things are relative, especially "allergies". I just had a pt. who listed Lipitor as an allergy because it gives her gas. Another pt. told my instructor that she was allergic to epinephrine because it makes her heart race.

#-o :laughing3:

Those are good examples of why we should ask a patient what happens when they take a drug that they say they are allergic to.

[firedoc5]

#-o :laughing3:

Those are good examples of why we should ask a patient what happens when they take a drug that they say they are allergic to.

Those are also good examples to ask whether it's an allergy or an adverse reaction. Most lay people don't differentiate between the two so the two are interchangeable. But if at all possible try and be specific.

One thing I was once told by a doc was that even though there was an "allergy" to ASA, keep a nebulizer ready. Evidently he had an MI patient that the thought of of anaphylaxis outweighed the MI. Never could quite figure that one out. Besides, I think he was a sub. in the ER.

[mrmeaner]

Those are also good examples to ask whether it's an allergy or an adverse reaction. Most lay people don't differentiate between the two so the two are interchangeable. But if at all possible try and be specific.

One thing I was once told by a doc was that even though there was an "allergy" to ASA, keep a nebulizer ready. Evidently he had an MI patient that the thought of of anaphylaxis outweighed the MI. Never could quite figure that one out. Besides, I think he was a sub. in the ER.

Exactly. A good assessment usually doesn't simply follow a flow chart.

[Trauma612]

CP W/suspected CVA [-X

:wink:

[aussiephil]

For us, our current contraindications are Allergy & Active or suspected bleeding or know bleeding tendency.

As Erdoc said it is risk versus benefit & the documentation (evidence) on the subject of the administraion is almost endless. The benefits to patients with ischaemic heart disease is huge, and should be a priority for all suspected cases.

There are trials here currently with the administration of Clopidogrel as an alternative where there is a history or fear of previous reaction, to date there is no data available on sucess.

[ERDoc]

CP W/suspected CVA [-X

:wink:

Please explain.

[Just Plain Ruff]

Please explain.

I'd hate to be that patient, not only do I have chest pain poss mi I've also got a CVA OY VEY