Aspirin is one of the most commonly used drugs in history. Aspirin is used for many different reasons. People use Aspirin for its cardiovascular blood thinning properties, for its pain relieving properties and for it antipyretic properties, to name a few. Most people don’t know what Aspirin
is, but only what it does for their particular needs. I will attempt to describe some different aspects of Aspirin and Aspirin overdose. I will give a brief description of what Aspirin is, chemically speaking and where aspirin originates from. The use of Aspirin for attempted suicide is common as a primary drug or as a co-drug. I will explain the possible signs and symptoms an overdose patient will experience, and the assessment, and the prehospital treatment for the patient.
Aspirin is derived from a chemical extracted from willow bark: Salicylate Acid. Salicylate Acid has a long history of uses. During Medieval times herbalists used it for its palliative properties. In the mid 1900’s, chemists isolated the active ingredient of willow bark, salicylic acid, and Aspirin was developed. It quickly became the drug of choice as a pain reliever, antipyretic and anti-inflammatory. The first company to develop Aspirin for commercial use
was the Bayer Company. Today Aspirin is used daily by millions of Americans to help reduce the risk a heart attack
. Until the late 1900’s, with the development of Aspirin alternatives such as acetaminophen and ibuprofen, Aspirin was the most widely used drug around, and a common drug of choice for the overdose patient.
Aspirin has many affects on the body when taken in excess amounts. One common affect is hyperventilation, which causes the patients PCO2 to drop from normal limits. The body will attempt to compensate for this by excreting bicarbonate, which results in an increase in pH blood levels. If this is not corrected, it will lead to metabolic alkalosis. Excess amounts of Aspirin will have many affects varying in severity such as severe illness, seizures, shock, and sometimes coma. Some of the more common symptoms include hypotension, tachycardia, tachypnea, nausea and vomiting, decreased level of consciousness, hypoglycemia, and tinnitus.
During the pre-hospital initial assessment of the patient with a possible Aspirin overdose, it is essential to stabilize all life threatening conditions. The patient needs to be placed in the ambulance for continuous vital sign monitoring including electrocardiogram (ECG). After all life threats have been addressed, the paramedic should focus on the history of the overdose. If the patient presents with suicidal tendencies, he/she needs to be evaluated by a Psychiatrist. The patient who presents with an attempted suicidal overdose should be questioned about other drugs taken. Aspirin is commonly taken as a co-drug during a suicidal attempt. If the patient took a narcotic and has a decreased level of consciousness the administration of Naloxone should be considered. Information should be gathered about underlying medical conditions that could complicate an Aspirin overdose, such as CHF or bleeding disorders. The patient should have his or her blood glucose measured because hypoglycemia is often overlooked in an overdose patient.
Treatment for the patient of an Aspirin overdose depends on the assessment findings. To paraphrase Paracelsus (1998): “The only thing which differentiates a poison from a remedy is the dose.” (p. 675) what this means to the paramedic is simple. The paramedic needs to determine how much Aspirin the patient has taken. The paramedic should administer 100% oxygen in an attempt to raise PCO2 levels within normal range (35-40 mm hg). Patients with Aspirin overdose are commonly volume depleted due to spontaneous vomiting and gastrointestinal hemorrhage. The paramedic should establish a patent IV line and attempt to replenish lost fluids. The use of syrup of ipecac has been restricted for use only with children and only if it can be administered within 30-60 minutes from ingestion. More commonly, treatment is focused on absorbing the Aspirin in the gut; the drug of choice for this is Activated Charcoal. The goal is to prevent the ongoing absorption of Salicylatic Acid which will benefit all other negative effects the overdose has caused.
Finally the patient needs to be transported to the emergency department for physician evaluation and blood analysis. In-hospital treatment depends on the severity of metabolic alkalosis. A common in-hospital treatment is the administration of bicarbonate to lower blood pH level and return the body to homeostasis.
In conclusion, Aspirin is a drug that is commonly used in many aspects of home health care. People take Aspirin daily for different reasons, including pain control and cardiovascular therapy. Aspirin overdose is a common finding and is often a co-drug in suicidal attempts. Overdose patients present with varying degrees of symptoms. Some of the more common symptoms include hypotension, tachypnea, nausea and vomiting, hypoglycemia and tinnitus.
When a paramedic encounters a patient who presents with Aspirin overdose, the paramedics primary concern is to stabilize all life threatening conditions, secondly, the paramedic must perform an in-depth patient interview in the attempt to establish how much Aspirin was ingested and how long its been since ingestion. Initial treatment for the patient with Aspirin overdose is the administration of 100% oxygen and continuous monitoring of the patients vitals signs and ECG. If indicated, the paramedic should administer Activated Charcoal to prevent the ongoing absorption of Salicylatic Acid. Finally, transport the patient to the emergency department for physician evaluation and blood analysis.