Author Archives: SWORBHP

TOTW: Naloxone and Allied Services

TOTW: Naloxone and Allied Services
Posted on: November 24th, 2021

Now that many first responders carry naloxone, remember that paramedics should not ask these providers to administer it.

The direction to administer or prescribe (direct the dispensing of a drug to a person) medication is a controlled act and therefore must be delegated by a physician.  You cannot delegate a delegated act to another care provider. This is operating outside of your scope of practice.

As the highest medical authority on scene, patient care should be provided as per the ALS PCS. Once paramedics have assumed care of the patient, other first responders may assist you in care provision. However, medications are to be administered by paramedics in accordance with the ALS PCS.

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TOTW: Auscultation Pearls

TOTW: Auscultation Pearls
Posted on: November 10th, 2021

From your 2021 MCME Online module on Differential Diagnosis:

Auscultation is an extremely important skill and should be used for (and documented) on all patients with complaining of shortness of breath. Some pearls to remember:
• Listen for a full respiratory cycle
• Ensure the diaphragm is placed on the patient’s skin (do not listen through clothing)
• Utilize a step-ladder approach, listening to both sides of the chest at the same level, before moving down/up to listen to the next level, to allow for comparison

For more pearls check out the 2021 MCME module on Differential Diagnosis.

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Can you please clarify what I should do if a midwife requests we transport to a different receiving facility as opposed to the closest?

Mom is having a post-partum hemorrhage CTAS 1-2 and there is a stable neonate, can we leave neonate on scene with Dad and call for 2nd unit for baby or can we leave? Do we have to wait until arrival of 2nd unit? No policy on this.

Hello and thank you for your time everyone. Module 2 point 2 reinforces the concept that high quality CPR is the primary focus for care of an opioid overdose VSA patient. However, It also highlights that naloxone may be administered as long as AHA guidelines for cardiopulmonary resuscitation are adequately being met. Given this point; is it o.k. for paramedics to administer naloxone for these type of VSA patients? The directive book and phone application Medical Cardiac Arrest directive continues to state, "There is no clear role for routine administration of naloxone in confirmed cardiac arrest". I found it a little unclear whether this segment was reinforcing the concept to not administering naloxone for a VSA patient, or providing guidance that it is acceptable as long as other aspects of care are effectively delivered.

Do you recommend a c-collar in patients with SGA or ETT in order to help prevent tube displacement?

I have recently read about recommendations/suggestion for the use of the distal femur as an alternative IO access sites specifically in pediatrics. Is this being considered as an option in Ontario?

Slide in conclusion portion of the course, states capnography waveform is gold standard for ETT/SGA tube placement. Previous slide during course states that this has no been studied on other airway except ETT. Can you please clarify this ambiguity.

As far as the LAMS is concerned, when assessing grip strength, what is the score for a pt who has normal grip on one side only?

The current AHA guidelines do not seem to support the use of back blows for conscious choking adults yet this is often taught in Red Cross or St. John courses. Am I mistaken or is there disparity between the current teaching?

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