ACLS Drugs – Aspirin

Let’s Talk About Aspirin

We know that aspirin can help save a life during a heart attack. But how does it actually do this? What’s going on? Why is aspirin so beneficial? To understand this, we have to look inside the coronary artery.

Aspirin can help save a life during a heart attack.

Plaque builds up inside the coronary vessel, which causes it to narrow. That restricts some of the blood flow through the vessel.

The culprit is the plaque rupturing inside the coronary vessel. As the plaque ruptures, it tears part of the inside of the vessels which causes bleeding. The bleeding then sets off a cascade of events to form a clot.

Related Video – Acute Coronary Syndrome – Chest Pain Suggestive of ACS

The first thing that happens during clot formation is that the platelets clump together. Aspirin prevents those platelets from clumping together. That is how aspirin helps save a life during a heart attack.

Related Video – What is Aspirin?

Aspirin prevents the platelets from clumping together. P= platelet, R= red blood cell, W= white blood cell.

Contraindications and Precautions

Let’s move on to the contraindications and precautions of aspirin. Two big questions to ask are:

1. Is the patient actively bleeding? For example, maybe the patient has an active peptic ulcer.
2. Does the patient have a hypersensitivity or allergy to aspirin?

Ask the patient, “Hey, are you allergic to aspirin?”

If the patient says, “Yes, I’m allergic to aspirin,” you may be thinking that you don’t want to give aspirin. Any time a patient says they’re allergic to anything, ask them specifically what happens when they take that drug.

Read: Dosage Calculation Explained

For example, “So what happens when you take the aspirin?” Perhaps the patient says the aspirin upsets their stomach. When you dig further, you note that the patient does not develop a rash hives, have trouble breathing, or anything like that. It just upsets the stomach. That would not be a true allergy. That’s a side effect of the drug. At that point, you can still administer the aspirin.

Overall, the patient may not know the difference between the side effect of the drug or an allergy. Therefore, make sure to ask specifically what happens to the patient for all reported allergies.

Dosing and Type of Aspirin

What kind of aspirin are you going to use? You need to use a non-enteric coated aspirin. Since aspirin can cause stomach upset, manufacturers coat the aspirin with a covering so that it is released slowly into the body. The coating helps to minimize gastric upset.

But when someone is having a heart attack, you don’t want that covering. You want the aspirin to get into the system quickly so that it prevents those platelets from clumping together and making the coronary circulation worse.

The type of aspirin to use for a patient experiencing a heart attack is chewable aspirin. Avoid enteric-coated aspirin.

Therefore, use chewable aspirin 81 mg (also known as “baby aspirin”). Instruct the patient to chew between 162 to 325 mg of the aspirin, as long as they do not have contraindications.

Remember how some drugs are administered sublingually, like nitroglycerin spray? The reason for the sublingual route is because it is very vascular under the tongue. It’s a great point of entry for drugs. If you go to a mirror and lift up your tongue, you will see a whole plethora of vessels underneath it.

That’s why we have the patient chew perhaps 324 mg (four baby aspirins) or a 325 mg tablet of non-enteric coated aspirin. Chewing gets the aspirin under the tongue and absorbed quicker into the body. Now for any reason the patient cannot take the aspirin orally, you can administer a 300 mg suppository of aspirin. The rectal suppository will work just fine and it is absorbed fairly quickly through the anal mucosa.

Summary

This article has reviewed the importance of aspirin in treating cardiac arrest and ACLS. Make sure to use non-enteric aspirin and always ask about contradictions and allergies.