Indications: Suspected cardiac ischemia
ASA: If the patient is ≥18 years of age or more with an unaltered LOA and is able to chew and swallow and has no sensitivity to ASA or NSAIDs, has no current or active bleeding, no recent (within past 24 hours) CVA or TBI then administer 160mg to 162mg of ASA PO.
Nitro-glycerine: If the patient is ≥ 18 years of age with an unaltered LOA, has a HR between 60BPM and 159BPM, has a prior history of Nitro use (or has an IV established) and has no known sensitivity to nitrates, has not used a phosphodiesterase inhibitor in the past 48 hours and 12 lead ECG does not indicate a possible Right Ventricular Infarct then administer 0.3mg or 0.4mg Nitro SL q 5 min to a maximum of 6 doses. If systolic BP drops by one third or more of its initial value then discontinue use.
Morphine: If the patient is ≥ 18 years of age with an unaltered LOA and is normotensive and does not have an allergy or sensitivity to morphine and has not had an injury to the head, chest, abdomen or pelvis then admin 2mg Morphine q 5 minutes to a max of 5 doses. If systolic BP drops by one third or more of its initial value then discontinue use.
 A Right Ventricular Infarct will most often result in the patient being bradycardic and hypotensive thus excluding them from the Nitro protocol. A Right Ventricular Infarct will show ST elevation in V4R and may also have an inverted Q wave. Be aware of possible JVD with clear lung fields.