Taking a recent call I did to a more extreme that it actually was: Patient that is symptomatic bradycardic with a valid MOH DNR provided by the sending facility. Patient meets aid to capacity for making her own decisions. After explaining what is currently happening to her and ensuring she is able to make an informed decision, she verbalizes to the crew that she desires intervention for her bradycardia (e.g. atropine/pacing/etc) hopefully to bridge her to a more permanent pacemaker, however should her heart stop she still wants nothing further done at that point. Can a paramedic honour a partial rescinding of the DNR like that? Is it an “all or nothing” thing even after the patient clearly stating exactly how she would want each scenario to play out?

When assessing for pelvic trauma do you use only 1 plane now (medially) and is there any reason to assess the symphysis pubis. It has changed for 3 to 1 but I cannot find the version.

I recently had a patient who was in severe respiratory distress. Pt was very pale and diaphoretic. He looked like a pre arrest pt. Pt was a 40-50s male. Pt denied any chest pain and had no other complaints aside from severe dyspnea. Pts only medical hx was an MI. Pts wife stated she “thinks” pt presented similarly with his previous MI. Pt had no wheezing upon auscultation and good air-entry, nothing obvious on 12 lead. Pt was tachy and Spo2 was 80% on room air but improved with NRB. Pt was otherwise vitally stable. My question- how would you treat this patient? Pt was impossible to get a hx from. He had 2-3 word dyspnea and got extremely agitated trying to answer questions and pts wife was also no help. I felt like I didn’t have enough info to make a decision. We treated with high flow oxygen. We felt like it could have been a PE, undiagnosed COPD or cardiac but it wasn’t clear cut either way

In regards to a DNR, can it be revoked by any reasonable SDM or do they also need to be POA?

I had a question regarding burns and trauma bypass: If I have a CTAS 1 burn patient, can I bypass to trauma hospital, or is there a requirement for trauma mechanism?

Hello, I was hoping you can put my overthinking mind at ease. I responded to a traumatic vsa. Single stab wound to the chest with the knife still impaled. Single stab wound to the lower left side of his chest(left of his nipple). He was asystole, very rigored at the jaw but no other obvious signs of “ Obivously Dead Criteria” My question is technically can we deem that enough to not continue resuscitative efforts? Or do they need gross rigor mortis at the extremities or lividity to call it? We decided to run the call as we did not feel comfortable calling it with just rigor at the jaw. Removed the knife as it was impending CPR, applied an asherman seal, rhythm analysis revealing asystole, double NPA with two handed seal and adequate ventilations with equal chest rise and fall with good air entry(did not needle decompress), end tidal of 20-22, IO access and transported. Arrival at the ER, got odd looks from ER team and got questioned why we transported someone who was rigored at the jaw and explained to them that we did not have enough to pronounce them on scene. Hoping you can give some clarification on this challenging scenario and whether I could’ve done that call differently. Thank you!

When giving Epinephrine for anaphylaxis is it expectable to delay administration of diphenhydramine following the first dose of Epinephrine if it is getting close to the 5 minute dose interval for the second dose of Epinephrine and the patient is requiring the second dose of Epinephrine? My understanding is that Epinephrine in anaphylaxis is the priority medication and I could use clarification as to whether or not it is okay to delay administration of diphenhydramine until after the second dose of Epinephrine if the patient requires a second dose and we were not able to administer diphenhydramine in between the required 5 minute dose interval for the second dose of Epinephrine.

I was hoping to get some clarification as to what a penetrating trauma under FTT guidelines is considered to be? I’ve seen many definitions that will define it as a breaking of the skin resulting in an open wound but wouldn’t a laceration fall under that definition? For example you attend a patient that has fallen resulting in a deep laceration to their head. Would that injury be considered penetrating and thus fall under FTT guidelines?

Should Midazolam be considered in the management of a trauma patient with trismus? In the absence of tonic/clonic seizure.

With today’s technology, are we allowed to honour DNR provided by phone? Eg. a photo?

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

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.