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?

This is a 2 part question: 1) Can we effectively administer the newly Provincially Mandated IntraNasal Glucagon 3mg (we carry 2 of them at our service + 1 I/M 1mg Glucagon) to treat either a BetaBlocker or a Calcium Channel Blocker OD? 2) Can it be used in conjunction with IV Glucagon to be within the therapeutic range of efficacy.

Question from an ACP role, For a pediatric patient who has a HR less than 60 with poor signs of perfusion (cyanosis/pale and apneic€¦..start chest compressions with airway and ventilations via BVM. The question is do we follow it up with epi? In the PALS algorithm it states to do CPR/ventilations, epi, atropine and consider pacing. This is covered under the newborn arrest directive however it is not covered under the adult/pediatric medical cardiac arrest. What does our base hospital want us to? Would it be appropriate to follow the PALS Bradycardia algorithm?

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