Question: There was a discussion among crews surrounding DNRs and our permitted treatment such as epi can be given for anaphylaxis or silent chest, but not as a pressor as listed on the DNR. That being said, I found a previous Ask MAC question where you addressed isolated epi administration as not very effective (where the BVM is contraindicated due to a valid DNR) in the situation of severe bronchoconstriction. Wondering if the same logic applies to the setting of anaphylactic VSA patients? If we cannot begin CPR or utilize a BVM, should we give isolated epi to that patient, as it is not being given as a pressor? (I’m of the opinion that a VSA patient gets no treatment in the presence of a DNR).

Question: My question falls under the category of Trauma Cardiac Arrests. Are we expected to check the pulse of a PEA patient, secondary to trauma, every two minutes? I believe we do as this follows heart and stroke and also verifies a PEA is in fact pulseless.

The BLS states to reassess pulse every 2 minutes under medical section 2-18, but trauma section 3-6, referring to trauma VSA, states to follow ALS patient care standards and protocols.

Our protocol does not state or outline the desired pulse assessment treatment during transport after the one analysis is performed. Thank you in advance.

Question: In the ALS patient care standards it states that a Supraglottic Airway (King) is indicated when “Need for ventilatory assistance OR airway control AND Other airway management is inadequate or ineffective”

In the “un-controlled” world of EMS would it not be more effective to use a King over an oral airway after the first round of CPR is complete? The King allows for movement from the floor to stretcher with no worry about “losing” your airway. It also doesn’t fall out as an oral airway will in the difficult situations/extrications we face in the field. The fear of gastric distention is also completely alleviated, making the King more effective. It would also allow for constant compressions, which is the best treatment for cardiac arrest patients in pre-hospital settings according to the Heart & Stroke. I have had many discussions with other paramedics and they seem to think that you can’t use the King at all if you have an oral airway that is giving adequate control. So my question is, if you use the King on VSA patients, is it acceptable even if the oral airway will work (just not as adequately or effectively in my opinion)?

Question: With the assumption that the Cardiac Arrest Medical Directive applies to patients > 30 days, and the Neonate Resuscitate Medical Directive applies to patients < 30 days, can we administer Epi to Anaphylaxis VSA patients under the age of 30 days? (We realize this is a VERY rare what-if).

Question: If a patient is between ages 8-12 and is VSA, are we still using the lowest Joule setting?

Question: Can there be some consideration to an inclusion of a (1mg-2mg) Naloxone standing order for VSA patients from a suspected opioid overdose as per current literature and practice?