Does the patient need to be actively smoking to count for the Condition of 20 pack-year history in order to administer Dexamethasone?

Does Vaping or marijuana use count towards the 20 pack-year history of smoking.

The vial of dexamethasone does not say that it can be given orally. Is it safe to give this route?

Why are we waiting to implement the cardiac arrest medical directive changes until Feb?

For ALS-PCS 5.0: If a patient re-arrested prior to extrication, do we carry out another 20 minutes of resuscitation or do we go after first analysis?

Can I attempt the Valsalva on a patient who has chest pain? What if the patient has a clear onset of palpitations, then after onset develops chest pain and or shortness of breath?

If a patient is capable – why is there a section for “Emergency Treatment of a Capable Patient without Consent”?

Why does Ketorolac in the Analgesia Medical Directive have normotensive as a condition, when other NSAID directives do not include a SBP condition?

What time-frame is considered Immediately after delivery for administration of Oxytocin if we arrive on-scene after the baby is delivered?

Under clinical considerations medical cardiac arrest, plan for extrication and transport after 3 analyses. For Pediatric arrest would we do 3 analyses and go or complete 3 on scene and 4th before departing in ambulance?

When would it be appropriate to treat a non-epileptic (or commonly called pseudo-seizure) with midazolam?

The ALS PCS shows specific suction settings (based on age) for tracheostomy and ETT but what about for oropharyngeal suctioning? Weve all been taught the values in school but I cant for the life of me find a specific and reputable reference.

My question is in regards to when an IV certified medic is working with a non-certified medic. If the certified medic establishes IV access and has a lock in place, but doesnt give any fluids or medications can the non-certified medic still continue to attend the call? Or does the certified one become the attending. Specific example would be a Code Stroke where we established IV access prior to leaving scene, but it was originally the non-certified medics call.

Should Ibuprofen be withheld for patients suffering possible Crohns, colitis and IBS flare ups?

I recently attended a CVA/TIA related call; it had been the first CVA related call I had been to since having a 4-year hiatus out of the trucks. Since being out the trucks the CVA consult/bypass protocol has been implemented. I’m having a difficult time understanding the point of the consult. If the Paramedic on scene is able to identify CVA symptoms accurately/appropriately, why are we delaying transport to discuss with a physician, who is not on scene, if we should transport to the appropriate stroke facility? It was explained to me that Paramedics weren’t correctly identifying CVAs pre-hospital. If that’s the case, those that aren’t recognizing a CVA aren’t performing a consult because they didn’t recognize the CVA in the first place. If I can identify a CVA correctly, announce a code stroke to dispatch, and have the stroke team ready on our arrival, how can there be any benefit to calling someone who knows nothing about the incident other than what I tell them? What is the difference between a doctor incorrectly identifying the CVA over the phone versus the Paramedic incorrectly identifying the CVA on scene other than the 15 minutes saved not trying to call for a consult? There also seems to be some significant discrepancies as to the onset of symptoms time frame between different receiving hospitals and physicians. Our destination guidelines clearly state within 6 hrs of onset of symptoms; however, recently a fellow medic advised me that it was 8 hrs but our guidelines have not yet been changed to reflect this, and a physician told me the window is 12 hrs. Any clarification/suggestions/info would be greatly appreciated. Thank you so much!

What is the rule for stroke bypass when symptoms resolve on scene? It doesnt specify for this scenario in the directive, and only says continue to bypass if symptoms resolve on transport. In this case our patients had stroke symptoms for 1-2 minutes that quickly resolved and he no longer had any symptoms. What is the most appropriate hospital in this scenario?

Hello I attended to a patient who was in adrenal crisis from Addisons disease. Pt presented with nausea/vomiting for 4 days, hypotension, GCS 14, tachycardia, fever of 38.8 tympanic with all other vitals within normal parameters. Pt had no food and minimal water intake for those 4 days. Pt had medic alert bracelet with adrenal crisis on one side and cortisol on the other. Pt states she has been taking her medications as prescribed. We asked pt if she had a vial when she was in an adrenal crisis and she said yes in my car and her family member went and got it. When they returned crew found it to say dexamethasone. My question is should we have called BHP for orders to give dexamethasone as our directive states hydrocortisone only for adrenal crisis pts.

Should we consider cocaine induced chest pain as ischemic and be treating with ASA and NTG? Example: 20 year old male patient midsternal chest tightness. Admits to using cocaine and the symptoms occurring after that. I guess my question is, is the cocaine causing ischemia which causes the chest pain?

I have a question in regards to the hypoglycemia directive. We were dispatched to a patient who suffered a fall, with history of diabetes. Upon assessment the patient was GCS 15, answering questions appropriately and oriented to person, place, time and event, however the patient was unable to move their limbs, and had loss of sensation in portions of the arms, torso, and legs, as well as a depressed skull fracture. The patient was hypovolemic and hypoglycemic at 3.2, stating he has not been eating or drinking fluids all day. Due to a complaint of back pain and paralysis, the a c-dollar was applied and scoop was used to extricate. Because the patient was secured to the stretcher supine, treating with oral gel was not an option, and transport was a priority. Some of the symptoms exhibited by the patient are concurrent with typical signs of hypoglycemia. In this situation where the patient is NOT altered, but hypoglycemic, with sufficient suspicion to suspect that low blood sugar may be causing some of the symptoms, would it be reasonable to treat the patient with IV dextrose? How do we proceed in situations where patients may be hypoglycemic, are not altered (GCS less than 15) but are unable to tolerate oral glucose or carbs? I can see this being the case for traumas.

Can you assist ventilations when a patient has a DNR? I had a call recently where a patient had a DNR, she was GCS 6, breathing spontaneously at a rate of 20 but there was very little air movement and an O2 sat in the low 80’s after we put her on a high concentration mask. I decided it was appropriate to assist her ventilations with a BVM to try to push oxygen deeper in her lungs. This did seem to help because when we arrived at the hospital she was now opening her eyes spontaneously, had a GCS of 10 and her O2 sats got to low 90’s. I just want to clarify the difference between assisted ventilations and using a BVM for resuscitation when it comes to DNR’s.

Have alternative pain control options such as oral morphine and nitrous oxide been (re)considered recently for pre-hospital administration? If not, what’s the reasoning?

For pediatric VSAs, at what heart rate do we initiate compressions?

Hello, question regarding cervical collar application. The BLS states that a collar should be applied with appropriate MOI if the Pt is altered LOC – however the Canadian Cspine flow chart states that cervical collars should only be used on stable, ALERT Pts. Is this a grey area where it is expected we use our judgement in terms of when it is appropriate to apply a collar vs manual cspine management? Or is there a certain GCS where manual cspine management is preferred over applying a collar? Thank you.

Why should Lidocaine be administered before Xylometazoline?

hello when treating a pt with adenosine the contra indications are active bronchial constriction on exam, the companion document also states that adenosine can cause bronchial constriction in asthmatic pts. so may question is … is an asthmatic pt contraindicated for adenosine tx or is more of a relative vs absolute situation

can you insert an OPA in an old person

What is the language for medical directives and inter-facility transfers with escorts? If a patient meets the indications and conditions for a medical directive and has no contraindications for treatment, and this is something you would treat in the field, if the nurse escort says no to your med administration – Whats next? For example, chest pain transfer for possible STEMI, sending facility gave 160 mg ASA and stated patient has had their full dose of ASA so they cant get any from EMS, and the sending doctor does not want patient having treatment from EMS.

Can you rationalize the administration of Epi prior to salbutamol in severe asthma exacerbation Pt? I know they both have bronchodilatory properties, just curious as to the additional benefits

Pt with Hx of URTI and a Dx of Asthma. With all signs of croup (Barking cough, low grade fever, severe respiratory distress) on auscultation you hear stridor and whizzing in lungs. Which treatment should be prioritized? Salbutamol vs Epi (NEB)? Thank you

When administering a fluid bolus to a cardiogenic shock patient, what is our targeted systolic blood pressure? Is it similar to that of a ROSC to target 90 mmHg, or reversing hypotension and targeting 100 mmHg?

Is it safe to use blanket warmers in the vehicles for warming IV fluids? I know that the infusion of ambient temperature (21°C) intravenous fluid may be a significant risk factor for severe hypothermia and the manufacturer of our IV fluids recommends a 40 °C for a max of 14 days. Do you know if this is being done anywhere effectively and safely and if so what are they using?

So we had a call to a burn victim that was grossly charred, but was breathing. He started to deteriorate in transport but we made it to the hospital. I was wondering if he were to arrest if that would be a traumatic VSA, I know it’s not a blunt or penetrating trauma but it doesn’t make much sense as a medical cardiac arrest either. Also could a patient meet the standards for an obvious death after patient contact?

I just have a question regarding analgesics. A contraindication for acetaminophen is use of it within the last 4 hours. Lets say for an adult patient they took 500mg prior to EMS arrival, would it then be okay to administer an additional 500mg to complete the full max single dose of 1000mg or should you withhold the acetaminophen in honour of the contraindication?

Just wondering, I have heard of a few coworkers putting the cardiac monitor on when giving acetaminophen and ibuprofen and others are not putting it on. I was under the impression that the monitor had to be on prior to giving medications. Is this a must or not?

Should I ask for a DNR in every scenario where I may use what’s contraindicated? If I were to show up for an unconscious but not VSA female and her husband is on scene and doesn’t mention the DNR, should I assume they want treatment and continue with inserting an OPA and bagging if necessary or should I ask for a DNR before starting treatment? Would I get in trouble in this scenario if I treated this patient without the husband saying anything and then once we got to the hospital found out they had a DNR?

Hello, two questions. 1. If I am bagging for a patient in respiratory distress but they do not have a supraglottic airway in, how would I measure their end tidal? Will just attaching my end tidal to the bvm without that same seal provide an accurate reading? 2. If I am assisting ventilations via BVM for a COPD patient who is in respiratory failure should I be concerned about their SpO2 going up to 100? Our current BVM’s don’t have a way to adjust how oxygen they are getting. I don’t want to make my COPD patients hypercapnic by delivering too much O2.

Can we give Gravol to a patient who is pregnant? Are there any concerns or is it totally safe?

Good day, forgive me if Im mis-reading this, but CPER digest Oct 2021 just published an info-graphic suggestive of staying on scene to run a complete 4 analyses in the case of a pediatric cardiac arrest with a suspected cause/history which is highly suggestive of hypoxia/respiratory in origin. The rationale that theyre presenting is that youve got an arrest where CPR and artificial respirations are our best bet for reversing the cause of the arrest. Any discussion related to this? I believe that our current SWORBHP directives are to depart after 1 analysis for a suspected reversible cause of arrest, (unless the rhythm is shockable). Thanks for any clarification that you can provide.

Curious. Obviously, the previous standard for spinal injury was full immobilization on a spinal board. BLS v3.3 currently states that those with suspected unstable pelvis should be secured onto a spinal board or breakaway stretcher (Scoop). We are then being referred to the blunt/penetrating trauma standard. There it also states to secure onto a spinal board or breakaway stretcher, and secure the lower extremities to reduce further injury/trauma to the pelvis. My question is, what is the current acceptable standard for this immobilization as per SWORBHP. Should this be full immobilization, 4 straps, headlocks etc? I do not see this written anywhere, and just looking for clarification as no one I ask seems to know the answer. Thanks

If a patient is given first time Nitro by a PCP IV but then isnt ever actually prescribed nitro by a doctor does this count as prior hx of nitro use? Could a then PCP non IV give this pt nitro the next time they call?

Does cpap have to be used with nitro

Hello, How would you like us to proceed with a young pt (say under 30) who complains of chest pain and describes it as ischemic pain, saying all the right things ex; pressure, heaviness etc. But who is vitally stable and doesnt not appear to be in any distress or severe pain. Would you still like us to treat it as ischemia on the side of caution even though its most likely anxiety/stess etc ?

If an IV medic attempts to start an IV on pt and the attempt(s) are unsuccessful do they have to remain the attending medic or can the non IV medic continue to attend the call?

Hello, I have a question regarding the 4th analysis when youre actively calling for a medical TOR. If theyre around Ill speak with family to give them an update on what weve been doing, that Im going to call and doctor and what the outcome of that phone call may be. Often, after Ive had that chat, and made the call by the time Im back the 2mins has passed and a 4th analysis may have been done by my partner. What would you like to see happen there. Do we perform that 4th analysis or is that only performed just prior to departure if were transporting. Thanks for your help.

If you attend to an unresponsive patient with diabetes paraphernalia (glucometer kit, dexcom, empty bag of candy, etc) on them and your glucometer is malfunctioning, do you have sufficient cause to administer dextrose or glucagon?

Can we give a lower dose of Tylenol than the dosage of 960-1000mg as written in our directives? I had a patient who would state she could only tolerate one extra strength Tylenol and taking two would upset her stomach. Would it be wrong to give her 650mg instead of 975mg?

Would the presence of De Winter T waves be enough to transport the patient to the cath lab. I know its considered a STEMI equivalent but there is no actual ST elevation.

Antiemetics: unrelated to our current directives but I was just wondering what the rationale was for specifically using dimenhydrinate as our prehospital antiemetic option? As I understand it, and I’ve had a number of conversations with physicians of different disciplines regarding the same, dimenhydrinate is most effective for motion sickness, and other antiemetics exist that are typically more effective for the types of emesis that we typically deal with in the field.

Why do you only give 3 sprays of nitroglycerin to a STEMI positive patient?

The updated AHA guidelines indicate an increase in the ventilation rate to 20-30 breaths per minute for children and infants respective in INTUBATED patients. Does this apply to patients who have a supraglottic airway in situ as well? Thank you!