The directive now states that we are to initiate transcutaneous pacing immediately if the pt is severely symptomatic/pre-arrest and not delay for IV access or atropine, etc. If they are in a spot that requires a lifting chair to extricate, should we wait until they are on the stretcher to initiate it or initiate then discontinue for extrication, reinitiate, etc. Then how would you like us to move the pt to the stretcher?

Hello, some further clarity/confirmations on the trauma cardiac arrest algorithm is still needed for a rather large group of paramedic students. Note, some of the “greater/less than” symbols in your previous replies show up as papyrus-esque and cannot be deciphered. Please reply with words only in case that issue repeats itself. -A patient with penetrating trauma to head/neck/torso in asystole (and no signs of life): if nearest LTH is greater than 30 min away, but nearest regular ED is 15 min away, we still patch for trauma TOR, right? Or do we transport to that nearest regular ED? -A patient with penetrating trauma to head/neck/torso in PEA: if nearest LTH is greater than 30 min away, but nearest regular ED is 15 min away, do we patch for trauma TOR (due to over 30 min transport time to LTH) or do we transport to that nearest regular ED that’s 15 min away? -A patient with a blunt trauma and asystole (and no signs of life) automatically gets a patch for TOR, right? -A patient with blunt trauma in PEA would only get a patch for TOR if there was no hospital (regular ED or LTH) that was less than 30 minutes away? Ie. Only patch for TOR if either ED or LTH were both over 30 minutes away. Thanks!

Question: Pushing a dose epinephrine seems to be very popular in the FOAM world for emergency physician. Its use has been promoted for things such as post cardiac arrest, refractory anaphylaxis, and severe bradycardia (some strong pharmacology reasons supporting it over atropine have been presented). Is this something you see being added to the advanced care paramedic treatment options at some point?

Question: I see that it says consider NaCl bolus in the cardiac arrest standing order. In the past we gave a bolus for PEA as well as Rosc’s. Can you confirm the exact circumstances we are to give the bolus as I find there to be a lot of gray areas in our orders.