When giving Epinephrine for anaphylaxis is it expectable to delay administration of diphenhydramine following the first dose of Epinephrine if it is getting close to the 5 minute dose interval for the second dose of Epinephrine and the patient is requiring the second dose of Epinephrine? My understanding is that Epinephrine in anaphylaxis is the priority medication and I could use clarification as to whether or not it is okay to delay administration of diphenhydramine until after the second dose of Epinephrine if the patient requires a second dose and we were not able to administer diphenhydramine in between the required 5 minute dose interval for the second dose of Epinephrine.

If a patient is VSA due to a trauma related mechanism, do you still trauma bypass to a LTH (lead trauma hospital).

Question: with regards to the Trauma Cardiac Arrest Medical Directive, do you support the placement of a pelvic binder on the patient assuming severe blunt trauma? I understand that under the Blunt/Penetrating Injury Standard in the BLS it is stated: “if the patient has a pelvic fracture, attempt to stabilize the clinically unstable pelvis with a circumferential sheet wrap or a commercial device”. Furthering this thought, the Intravenous and Fluid Therapy Medical Directive found within the ALS PCS now states: “An intravenous fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes.” Thinking about this all together has me wondering that if a patient who is VSA secondary to severe trauma is eligible to receive an IV bolus to presumably treat hypovolemic shock, would the use of a pelvic binder be supported in the same way? If so, when would be the recommendation to apply a pelvic binder when treating under the Trauma Cardiac Arrest Medical Directive? Thank you.