For Oxytocin administration, can you please clarify if the placenta has to be out prior to. Or can the patient have Placenta in and us administer Oxytocin as long as baby is out?

I have an question regarding the symptomatic tachy/brady directive. A patient with a hx of atrial fibrillation, currently in a rapid afib at 180 BPM. But they have periods of chest pain and pre-syncope every minute or so due to a sinus arrest lasting approximately 8-9 seconds before they flip back into rapid afib. My understanding is that sick sinus syndrome is often the culprit, which can cause alternating rhythms on an ECG and needs to be treated in hospital. In terms of ACLS and pre-hospital care, which would be most appropriate? cardioversion or pacing? providing indications are met and the pt is unstable. Hypothetically, in different scenario, a patient with an underlying regular/brady rhythm and prolonged symptomatic runs of Vtach. What would be most appropriate in that scenario? Any input you could provide is greatly appreciated! Thanks

When having a pt with a spontaneous abortion at 12 weeks. Fetus is visualized on scene and pt is having vaginal bleeding as well as intense cramping (10/10) that comes and goes occurring ~3-5 minutes. Would it be appropriate to give Oxytocin for the hemorrhage?

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?

Is there a gestational age limit on administering oxytocin? For example, you have a patient that has miscarried in the first or second trimester and is hemorrhaging heavily after passing the fetus, would it be appropriate to treat with oxytocin?

Should we administer oxytocin in event of a miscarriage? If so, is there a minimum gestation?

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

Mom is having a post-partum hemorrhage CTAS 1-2 and there is a stable neonate, can we leave neonate on scene with Dad and call for 2nd unit for baby or can we leave? Do we have to wait until arrival of 2nd unit? No policy on this.

Question re potential med administration through a PICC line; would it be prudent to patch to Base Hospital for direction/permission to administer Gravol for example, in a pt who is declining additional IV initiation but already has a PICC line established and knowledge of how they self-administer their own medications? Thank you.

I have a question regarding our new Emergency Childbirth Medical Directive. My understanding from the protocol is that we can stay on scene to deliver a breech presentation, but for a limb presentation we must transport immediately. I know that we can deliver a complete breech and a frank breech, but what about a footling breech? Is that considered to be a limb presentation that requires immediate transport?

Question: Although very rare, how should Paramedics manage a uterine inversion?

Question: Can calcium gluconate be given through a CVAD? The patients requiring it (usually dialysis patients) often have difficult IV access, unstable veins and some sort of CVAD in place. If access of the CVAD for administration of fluids and cardiac arrest meds has already been performed, are we still required to start an IO for the calcium gluconate or can it be requested of the BHP to administer through the CVAD with proper flushing before and after?

Question: I was just wondering how CVAD access should be documented on the ACR? There is no specific code for CVAD. Is it ok to document using the Normal Saline code (345) and just specify that it was via CVAD in remarks? Should I always get blood when I aspirate? (I didnt but it seemed to flow well).

Question: On our ROSC protocol, the ONLY route that we are allowed to give a fluid bolus/dopamine is via an IV. Please confirm that we are NOT allowed to do so via IO or CVAD? This does vary from the IV and Fluid Therapy protocol which allows us to do so.