If I attend scene and the patient has already received care outside of the 911 system (i.e. fluid bolus with homecare or community paramedicine), and they are still hypotensive, can I provide further care via the ALS-PCS (i.e. fluid bolus for a hypotensive patient)? Would I only be able to give 20cc/kg IVF bolus including the fluid administered before my arrival?

If I have successfully inserted an SGA and then have to remove it, due to vomitus; do I have 2 further attempts at re-insertion, or is it 2 attempts total despite having successfully completed an insertion previously?

This is a very unlikely scenario, but I wondered if Toradol could replace Ibuprophen for the patient experiencing pain. In the unlikely event that a patient is able to take Tylenol and once administered pt refuses Ibuprophen due to nausea (post tylenol administration) could Toradol be used? It would be rare as the contraindications are the same for both nsaids aside from nausea and unable to tolerate oral med administration for Ibuprophen. Could pt preference come into play, a patient in severe pain states “I have had toradol in the past and it works really well for me” assuming all other conditions are met could they receive toradol in addition to tylenol to compliment the nsaid?

Recently brought a pt in to hospital that was negative for facial droop, slurred speech, arm drift and has equal grips. His complaint was on dizziness but he also was being treated for a uti. Nursing staff tested his arm drift again and had him close his eyes which threw him off. Is that the proper way to assess for arm drift to have a pt close their eyes while doing it? Thank you for your help

If a patient is in pain and states they don’t like taking Advil or can’t take Advil (but no allergy), would it be appropriate to administer Tylenol and Toradol? They are not contraindications of each other.

I need some clarification on the updates to the trauma arrest algorithm. With a patient with penetrating trauma in asystole with LTH less than 30 minutes are we to transport to the lead trauma hospital as we do with PEA? Also, if the lead trauma hospital is greater than 30 minutes, I am assuming we transport to the closest ED with both asystole and PEA with penetrating trauma.

Recently we attended for a call at a marina for an unknown traumatic injury involving a PWC (personal water craft – SeaDoo). After assessing the patient and confirming the MOI from eye witnesses it was revealed that the patient was the driver of the PWC who struck a 20 foot fiberglass pleasure boat while both vessels were underway at “at least 50 K/H”. It was unknown if the patient has a loss of consciousness however when the boat turned around to pick him up he was conscious but “dazed”. The patient has no complaints when asked initially but it was quite obvious by his mangled left foot that it had likely been struck by the propeller. He had lost a significant amount of blood prior to EMS arrival and the bleeding was uncontrolled with a dressing and direct pressure. Our ambulance was more than 30 mins to transport the patient to the closest appropriate hospital so we decided to request for ORNGE based on motorcycle crash of equal to or greater than 30 km/hr as well as his injuries. When we met the ORNGE crew for a modified transport at the closest local hospital they declined to take the patient and one of the reasons was that he did not meet the FTTS as it was not a vehicle or motorcycle accident. So the question is, are all other modes of transport/recreation not to be included in the FTTS? There are so many different types of recreational vehicles that I think the wording in the FTTS should be inclusive of all modes of transportation/recreational vehicles due to the inherent dangers associated with the speed they are capable of and the lack of safety, eg.- no helmet on a PWC.

In the companion document under the medical cardiac arrest directive it lists reasons for early transport. Under here it lists thrombosis (pulmonary and coronary). So to my understanding, if we have a VSA we believe to be caused by a coronary thrombosis (a STEMI) we are to do 1 analyze? In the past it has been said that we are to treat a suspected MI VSA as a medical cardiac arrest and run the entire protocol on scene. Can you please clarify?

In a challenging scenario: You respond to an unplanned home birth on a stormy winter day, with a backup unit facing delays due to adverse weather conditions. Upon arrival, you encounter a situation where a baby requires neonatal resuscitation, while the mother remains in a stable condition. Is it advisable to consider leaving the mother on site and transporting the newborn?