Question: I have a question regarding the administration of narcan. Narcan seems to be given more often now that there is no patch point. The wording of the medical directive hasn’t changed though so just to confirm, are we still just to be giving it when we cannot adequately ventilate the patient? Example, if they are GCS of 3 and breathing inadequately but we are getting good compliance on the BVM and the patients vitals are otherwise stable, are we ok to not give it? If we do go ahead and give narcan to a patient who is NOT breathing and they start breathing on their own but are still GCS of 3 are we to stop there since we can now manage their airway or do we continue up to our maximum of 3 doses or until they become GCS of 15?

Question: In reference to LOA and gravol administration: a patient who has had a fall and struck their head, has a GCS of 14 (4,4,6) and is alert to person but not place and time, confused about previous events, but can follow commands and is answering some questions appropriately (ie… Birthday, wifes name). Does this rule them out for gravol? My concern is if they are nauseated and we dont treat it early, vomiting and being supine on a spinal board can be very difficult to manage by yourself. I appreciate the definition of LOA is a GCS less than normal for the patient. Can you explain the reasoning for this condition?

Question: I don’t agree with the transport consideration in case study #1 of the Acute Stroke Protocol that states the patient is excluded from transport to a Designated Stroke Centre due to not being able to determine onset of symptoms: male, age 58, found unconscious on the floor at 0800 by a friend, when he came to pick him up for work.

Shouldn’t we consider it likely the symptom onset was < 3.5hrs especially in this case where it would be safe to assume symptom onset probably occurred after patient got up to get ready for work and that he probably does not get up three and a half hours prior to getting picked up at 0800.

Further, it’s more likely his GCS would be worse than 10 had he been down much longer. Bottom line, shouldn’t we be erring on the side of caution for these patients and give them the benefit of the doubt that symptom onset might be < 3.5hrs given the evidence at hand? Or even with less evidence? As an aside, is the time going to be extended as i believe some doctors think it should?