Cardiac Ischemia Medical Directive

IM HAVING A HEART ATTACK

Indications

Suspected Cardiac Ischemia

Medications

• ASA (Aspirin)

• Nitroglycerin

ASA Conditions

• = or > 18 years

• Unaltered LOA

• Able to chew and swallow

Nitroglycerin Conditions

• = or > 18 years

• Unaltered LOA

• Normotension

• Prior Hx of Nitroglycerin use or IV access obtained

ASA Contraindications

• Allergy or sensitivity to NSAID’s

• If asthmatic, no prior use of ASA

• Current active bleeding

• CVA or TBI in the previous 24 hrs

Nitroglycerin Contraindications

• Allergy or Sensitivity to nitrates

• Phosphodiesterase inhibitor use with the previous 48hrs

• SBP drops by one-third or more of its inital value after nitro is administered

• 12-lead ECG compatible with Right Ventricular MI

ASA Route

PO

ASA Dose

• 160-162mg

• Max 162mg

ASA Interval

N/A

ASA max # of Doses

1

Nitroglycerin route + SBP

• SL

• = or > 100mmHg

Nitroglycerin Dose

• 0.3 or 0.4

• 0.4 max

Nitroglycerin Interval

5 min

Nitroglycerin Max # of doses NO STEMI

6

Nitroglycerin Max # of doses STEMI

3

Nitroglycerin Clinical Considerations

DO not administer to pt with R.Ventricular STEMI

Clinical Considerations

• Suspect a R.Ventricular MI in all inferior STEMI’s and perform at minimum a V4R to confrim

• Apply defibrillation pads when a STEMI is identified

• The goal for time to 12-lead ECG from first medical contact is <10 mins where possible