asked 2 years ago
This question was emailed to me on the weekend so I thought why not put it here. The example was:
Patient is experiencing chest pain and also fractures their ankle. While the directive states suspected ischemic chest pain is a contraindication to analgesia, these are 2 separate events and would it be appropriate to treat them each accordingly? Would the analgesia affect the patients chest pain perception?
1 Answers
answered 2 years ago
Thankfully the scenario where a traumatic event includes cardiac ischemia is low, the question regarding use of analgesia is important. Although the current evidence for narcotics in cardiac ischemia is questionable at best, the AHA still includes morphine as a treatment for this disease process. Morphine also remains a treatment in the ALS PCS for cardiac ischemia. I would therefore recommend that if you are to treat a trauma patient who is experiencing cardiac ischemia symptoms, you should use morphine as indicated in the ALS PCS. For PCP paramedics who do not carry narcotics, acetaminophen would be reasonable to treat pain (other than cardiac ischemia pain) and NSAIDs should be avoided. The really tricky part with a traumatic patient who is experiencing cardiac ischemia symptoms is whether or not to administer ASA. This really depends on the nature of the trauma. The risk of bleeding from the trauma vs the benefit of antiplatelet therapy for the cardiac ischemia would need to be considered. This decision may be best done at the hospital.
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