Final answer:
The appropriate next action for a STEMI patient with a history of gastritis who has not taken aspirin would be to administer aspirin as ordered (Option A), considering its crucial role in preventing further clot formation. Consultation with a gastroenterologist may be advisable to balance the risk of gastrointestinal side effects.
Step-by-step explanation:
The subject of the question revolves around the management of a patient with ST elevation myocardial infarction (STEMI) who has chest discomfort and a history of gastritis but has not taken aspirin due to this history. Considering the fact that the patient is undergoing fibrinolytic therapy, which will include the use of a thrombolytic agent, and that the patient is also on a heparin drip, it is crucial to address the risk of further coronary artery blockage with effective anti-platelet therapy. Despite the patient's history of gastritis, the immediate risk of myocardial infarction outweighs the potential gastrointestinal side effects of aspirin. However, patient safety and potential contraindications should be carefully considered.
Given this information, option A) Administer aspirin as ordered would be the next action. This is based on the general principle that aspirin is a core component of the treatment protocol for an acute MI due to its anti-platelet effects. Anti-platelet therapy is critical in the management of STEMI, and the combination of aspirin and clopidogrel, known as dual anti-platelet therapy (DAPT), offers a significant reduction in cardiovascular events post-MI. A gastritis history treated five years ago does not automatically preclude the administration of aspirin, especially when a life-threatening condition such as STEMI is present.
Before administering aspirin, it would be prudent to consult with a gastroenterologist regarding the patient's history of gastritis and the necessity of including an anti-platelet agent in the patient's treatment plan, as there may be strategies to mitigate the risk of gastrointestinal side effects, such as using proton pump inhibitors (PPIs). However, the urgent need to prevent further clot formation in this scenario typically necessitates immediate aspirin administration, so long as there are no absolute contraindications.