Crew responded code 4 to possible allergic reaction. PT was a bad historian, who states he has a chest pain post being stung by a wasp. Pt had swelling on the left side of his lower lip where he got stung. PT complains of dizziness/lightheaded. PT had no adventitious sounds in the lungs. PT complained of mild nausea with no vomiting. No incontinence. PT complained of weakness as well. During the assessment, pt complains of chest tightness post the wasp sting, all the answers to CP questions were leading the crew to believe that patient was experiencing ischemic chest pain. Pt states he has hx of allergic reaction to bee sting. Vitals: 58, sinus bradycardia with LBBB in 12 leads noted. BP: 86/42, RR 22, Sat of 90%. In this case, pt is showing signs of anaphylaxis with multiple symptoms being affected and known allergen exposure, but complaining of ischemic sounding chest pain. Is the crew to be treating with Epi, or should the crew withhold the epi as patient may have ischemic chest pain and it can worsen the cardiac symptoms?

Is there a reason why epinephrine dosing intervals in cardiac arrest patients is set to q4min instead of q3-5 minutes as per AHA guidelines? By having them set at q4min, it puts the provider in stressful situation trying to sequence the doses at a speicific time rather than a range as suggested by AHA.

With regard to the croup protocol, I am looking for clarification on the indication of “history of URTI.” Does this need to be diagnosed in hospital, or can recent symptoms of an URTI be enough? If the symptoms are enough, how long should the patient present with them for it to qualify as an URTI?

Are we still withholding EPI in bronchoconstriction for greater than 50 year old patients? It’s not in the protocols to but I remember the memo from Feb 2021 saying to withhold it.

Why do the pandemic guidelines allow for the administration of 2 doses of epinephrine (<50y) in bronchoconstriction (asthma exacerbation) vs the ALS PCS allowing only a single dose (without age guideline)?