Alternative routes of administration for STEMI

Here is my attempt at a trick of the trade. This one is focused on the intubated STEMI patient in whom the EMS crew couldn’t get the 324mg of aspirin on board, and the cardiologist wants to load with clopidogrel 600mg as well as atorvastatin 80mg. Provided we can drop an OG tube before the patient gets sent to the cath-lab, this is how we get the meds into the patient:
Grab a Toomey Tip 60mL syringe, the meds, some water and something to crush the tablets (In our ED, commercial pill crushers disappear within a day, so we often use a blunt object located nearest t0 the pharmacy).

First, crush the tablets while still in the blister pack so fragments don’t go flying everywhere (easy to do with chewable aspirin, not so much with clopidogrel and atorvastatin).

Draw up about 25 mL of water into the syringe from the cup. While plugging the end of the Toomey tip with your thumb, remove the plunger of the syringe.

Dump the contents of the crushed tablet blister packs into the syringe through the opening created by the missing plunger.

Return the plunger into the syringe, and shake (Don’t take your thumb off the Toomey tip unless you want aspirin/Plavix/Lipitor shake all over the place).

Draw up some extra water (to a total of about 45-50mL).
If there are still some tablet fragments after administering, draw up an extra 25-30mL of water to flush.
Done and done.
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