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Is astma a contra indication to administring asprin in a MI (query)?
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#1 Posted : 10 September 2003 00:00:00(UTC)
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Asprin is except as one of the main fiarst aid treatments for heart attacks along side o2 and possitoning them. However in the 8th eddition and other books the only counter indcation listed is stomch ulcers or a none allergy. However astamtics should not take asprin or similar drugs eg ibuprofen as it may cause an attack. But is it acceptable to administer asprin in the case of a susspected MI ? any views sorry to be dense

Posted by mountainman
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#2 Posted : 10 September 2003 00:00:00(UTC)
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Mountianman.

The only dense question is a question not asked.

In answer to aspirin & asthama, I have copied the following from the national asthma council australia site

http://www.nationalasthm...nalgesic/analgesic.html

Putting Aspirin-Sensitive Asthma into Context

People with asthma purchasing analgesics need advice from their pharmacist.

"The prevalence of aspirin and NSAID-sensitive asthma in Australia is probably as low as 5-10 per cent in all adults with asthma," said Dr Christine Jenkins, thoracic physician and Chairman of the National Asthma Campaign. "In the majority of people with asthma, NSAIDs like ibuprofen are well tolerated and effective, as long as the patient has no previous history of aspirin or NSAID sensitivity or a significant history of dietary sensitivities that cause asthma."





The other thing to think about, as with all drugs, is the benifits versus side effects. If I give asprin to the cas having an MI, what is the benifit, If I dont give will it have a negative outcome etc.

I have previously given drugs to crew (as a medic) which although they (the cas) said they were allergic to it, the benifits far outwieghed the negatives.

Having said all the above. In answer to your question my BNF states that Asprirn is a caution to Asthma, not a contra indication

I hope this helps

Regards
Michael Rattigan

Posted by ratty
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#3 Posted : 11 September 2003 00:00:00(UTC)
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Thanks thats fairlly consise i think if the casulty has never had problems then i would administer it. As for countra indication verses caution i was reading the bottle rather than the BNF(one for the shoping list) many thanks MM

Posted by mountainman
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#4 Posted : 11 September 2003 00:00:00(UTC)
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To put it even more simply than Ratty;
To give the aspirin may save the life. Would it kill the cas to have aspirin if they were allergic, bearing in mind they might be dead from the heart attack anyway?
Rules are meant to be broken, reasons are meant to be understood.


Posted by mediact
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#5 Posted : 02 October 2003 00:00:00(UTC)
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Regarding Aspirin being administered to a casualty with a suspected heart attack.
We are only First aiders and should never offer any form of medication to a casualty.
However we can allow the casualty to take his own prescribed medication or his own asprin.
If we give any form of medication to a casualty and something goes wrong, we are in for the high jump.
Don't do it !!

D scorgie
Aberdeen

Posted by derek
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#6 Posted : 02 October 2003 00:00:00(UTC)
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All good and well made points guys but bear in mind that although aspirin is cautioned rather than conta-indicated in asthmatics, the side effect reported by aspirin sensitivity in asthmatics is bronchospasm!

So I guess, if the asthmatic patient suffering an MI was sensitive to aspirin it possibly could kill him?!

I teach that before giving aspirin to any suspected MI patient, ask if they have taken aspirin before and been OK and secondly if they are currently taking or being prescribed any other medications? If Ok on aspirin before and not taking anything else - let them have aspirin as asthmatics and most other cautions/contra-indications or drug interactions will be ruled out. Also Aspirin interacts with Warfarin (which many heart patients may be on) which is described as being a 'special hazard.'

Posted by Pilotmedic
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#7 Posted : 03 October 2003 00:00:00(UTC)
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As mentioned it approved in the VAS manuall to give sprin hence thats what i wud do. Although the manuall mentioned ulcers (stoomach) it does not mention astma.

Posted by mountainman
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#8 Posted : 03 October 2003 00:00:00(UTC)
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I have to say I agree Ian, Aspiring is in the First Aid Manual - so the lay person is covered by that. However, as a precaution, I see no problem if another person has aspirin available and the first aider makes the aspirin available to the casualty for them to take (self administered - it probably is better than saying "here take two of these!"

Incidentally, you would have problems in the workplace if the aspirin was seen as part of the first aid provision as it could contravene COSHH Regulations unless a risk assessment has been undertaken, data sheet obtained and appropriate training given.

I would challenge anyone to be able to cite any case in the UK (or USA) where a 'lay' person has ever been successfully sued for negligence whilst acting as a 'good samaritan' (first aider). If you can - please quote X versus Y, date, and outcome.

Incidentally we have a medical lawyer working with us,also an RN, I'll get her opinion on first aiders giving aspirin and post it in due course.



Posted by Pilotmedic
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#9 Posted : 03 October 2003 00:00:00(UTC)
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It might also be an idea to ask if the casualty has ever had a stroke and to find out what other medication they might be taking such as warfarin.

Posted by booty
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#10 Posted : 03 October 2003 00:00:00(UTC)
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Derek, read the book aside from any contra-indications Aspirin is actually recommended see page: 125,Joint First Aid Manual.

Posted by ianross
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#11 Posted : 04 October 2003 00:00:00(UTC)
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Hi PilotMedic,
This was covered a few months ago:
Have a look here:
http://www.firstaidcafe....rumID=9&topicID=36&ARC=

I've tried to edit my comments into a readable order below:

The Bolam test (with an A!) is a test of the Duty of Care that a FA owes to their patient. It was introduced in the case of Bolam v Friern Hospital Management Committee.
The quote from the leading judgement of McNair J "A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. Putting it another way round, a doctor is not negligent if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view"
With me so far?
The courts are trying (so far relatively unsuccessfully) to move away from this ruling. It is interesting to note that this requirement of a standard of care is also imposed upon trainees.
If there is a conflict of opinion between two "expert authorities" the courts will follow either one.
The vast majority of cases concern doctors & surgeons rather than FAs.
Generally speaking the courts are very very wary of convicting "rescuers" of any sort.
It would go against moral reason. "Yes, I'm trained to help you, but I'm scared of you sueing me, so I'm gonna watch you die"
Simply speaking, as long as you only treat 'inside' of your knowledge base, ie that which you have been taught, then you should be OK. It's when people with AP who've watched Casualty and ER for a few years start trying to things!!
The trouble with legal issues is that as they are so convoluted they are easily misunderstood. For example, I was recently told by a colleague (RLSS T/A) that it was no longer acceptable to pinch somebodies ear to check responces as it is assault - which very strictly speaking is correct, but it would be practically impossible to ever bring an action.
If you ask me, legal reprecussions shouldn't even cross anybodies mind when doing FA.
If anyone wants any further explanation or details (regarding anything legal) please get in touch with me, and I'll do my best to help.
I've done a fair bit of research on WestLaw (an international legal database) and cannot find one case of Medical Negligence that involves a First Aider. There are a couple that question the Ambulance service - although they are more to do with the delay, rather than any malpractice by the personnel. Cheers. WMM

PS. For those who are interested, below is the WestLaw summary of the Bolam and Bolitho cases, if anybody would like a full report, let me know.

Bolam v Friern Hospital Management Committee
(QBD) Queens Bench Division
26 February 1957
Summary: A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular form of treatment; nor is he negligent merely because there is a body of opinion which would adopt a different technique. In deciding whether a doctor is negligent in failing to warn a patient of the risks involved in a particular treatment, it is appropriate to consider firstly whether good medical practice required that a warning should have been given to the patient before he submitted to the treatment, and, secondly, if a warning had been given, what difference it would have made. The plaintiff sustained fractures of the acetabula during the course of electro-conclusive therapy treatment given him while he was a voluntary patient at the defendants' mental hospital. He claimed damages against the hospital alleging that the defendants were negligent (1) in failing to administer any relaxant drug prior to the passing of the current through his brain; (2) since they had not administered such drug, in failing to provide at least some form of manual restraint or control beyond that given; and (3) in failing to warn him of the ris
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#12 Posted : 06 October 2003 00:00:00(UTC)
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so who would give asprin to some one having a heart attack who also had astma?( go on stanf up and be counted) as stated the BNF listesit as a caution rather than a contraindication. Flicking through another book it listes gastrointestinal bleed/peptic ulcers, and and allergy to asprin or other NSAID as contrindications. However it is not a FA book it does not however mention hemophillia which is also listed as a contraindication in the BNF is this an irrelivence or is it not listed because its not that common.

Posted by mountainman
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#13 Posted : 16 October 2003 00:00:00(UTC)
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As a first aider and an asthmatic I would have no problem with administering Asprin as long as I had checked that the casualty had no prior history of allergic reaction to the drug

Posted by digitech
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