November 1999
First aid for a heart attack. Detailed guidelines for assisting a person who has chest pain with his/her nitroglycerin and / or with ASA (Aspirin™) are provided.
Rationale
Current research has shown that early administration of 160 – 325 mg of ASA can reduce the effects of a heart attack by as much as 20%. The ECC Coalition recommends that all individuals who are experiencing acute onset of chest pain which may be cardiac in origin be encouraged to chew 160 – 325 mg of ASA regardless of whether they normally take ASA or not. This recommendation must be considered within the context of local health regulations, existing protocols, professional regulations, medical supervision or other governing authority. For example, you should comply with the regulations or protocols which apply to your profession / organization if they are in conflict with this recommendation.
Teaching Points
An individual who is experiencing chest pain should be assisted with his/her prescribed medications and ASA (whether prescribed or not) in the following
way:
1. As soon as chest pain is detected activate the emergency medical services system. Call 911 or your local emergency number.
2. While waiting for medical help, assist the person to the most comfortable position, usually semi-sitting with the head and shoulders raised and supported. Loosen tight clothing at the neck, chest and waist. Reassure the person. Assist the fully conscious person to take appropriate medications as described below. If your profession is governed by regulations that preclude this action, you should not proceed.
2.1. Ask the fully conscious person if he/she uses Viagra®. If the person has taken Viagra®; do not assist them to take nitroglycerin (go to 2.2 ASA). If the person is taking nitroglycerin ask them if they are taking Viagra®. Ensure that you have the correct medication before assisting the person. The nitroglycerin may be either tablets or spray. Nitroglycerin tablets are placed under the tongue where they quickly dissolve. Nitroglycerin spray is sprayed under the tongue and is rapidly absorbed. Nitroglycerin starts working within one to two minutes and works for about five to six minutes. The nitroglycerin dose may be repeated every 5 minutes until the pain is relieved or until a maximum of three doses have been administered.
2.2. Ask the fully conscious person if he/she carries ASA. Ask if he/she is allergic to ASA. If the fully conscious person does not carry nitroglycerin or if the pain is not relieved by the first dose of nitroglycerin, suggest the person chew 2 children’s ASA tablets (80 mg each) or one regular adult dose ASA tablet (325 mg). You may offer Aspirin™, but you are cautioned to only recommend that the person take the Aspirin™ and explain why. The individual must make the decision whether or not to take the medication. The ECC Coalition recommends that ASA should not be given to individuals who have asthma or who have a known ASA allergy without the direct order of a physician. While a bleeding peptic ulcer or concurrent use of Coumadin®/Warfarin® is generally accepted to be a relative contraindication to the use of ASA, a single 160 – 325 mg dose of ASA in the context of chest pain, should be safely tolerated. ASA will not relieve the chest pain. Do not repeat the dose. Do not substitute acetaminophen (Tylenol), which does not have the same effect as ASA in reducing damage due to heart attacks.
2.3. When the EMS arrives, advise them of any actions or medications that have been taken.
3. Monitor respiration and pulse and be ready to provide artificial respiration or CPR, if needed.
