I was just curious about a possible contradiction in the Trauma TOR VSA Conditions/Contraindications. In the updated Trauma TOR Conditions it lists that a condtion as “Signs of life when fully extricated with the closest ED >30 min transport time away”. However in the following contraindications it lists “Signs of life at any time since fully extricated medical contact” as contraindicated for the TOR. My question is, in a scenario of a Trauma TOR eligble patient that has signs of life after full extrication, then becomes VSA, would the Trauma TOR apply or not? Would distance to the hospital come into play?

In regards to the contraindication for NTG regarding SBP dropping by 1/3 or more, should we basing this off the very first BP obtained on that call, or a BP obtained right before NTG usage? Ie. ischemic chest pain 00:00 BP of 180/100 00:03 SBP of 150/90 00:04 NTG usage 00:09 BP 115/75. In this case a 65 (180-115) point drop would rule us out if 1st BP counted, but a 35 (150-115) point drop would not rule us if BP prior to NTG used. As pts can often be particularly stressed/anxious right when we walk in the door, it would make sense to me that the BP closest to actual administration would be most indicative of their true clinical state.

What constitutes as tbi? Does every fall were the person struck their head mean that they can not have any pain management or is there a symptom we can look for to narrow down the risk of increasing bleeding?

If a patient has self-administered benadryl prior to our arrival, should a paramedic re-dose under the Allergic Reaction Medical Directive? There appears to be no contraindication for this in the directive. As well, the direction per the Medical Directive in the OBHG Companion Document is, diphenhydrAMINE administration should always follow the administration of EPINEPHrine as outlined in the Medical Directive. However, I have heard from my more senior colleages that we should not re-dose the benadryl, like we can the epineprhine. Can you please clarify?

I have a question regarding the PCP analgesia medical directive. If a patient has been using topical gels for pain relief (such as voltaren gel containing diclofenac), is ibuprofen/ketorolac still contraindicated if it has been used within the last 6 hours?