Author Archives: SWORBHP

Question: I was looking through Ask MAC and there are a few questions pertaining to cardiac arrest and shocks or no shocks of other responders. Are Paramedics are to include shocks delivered by the Fire Department prior to arrival in their treatment of a VSA patient?

My understanding from teachings in 2014/2015 is that if Fire delivered shocks we could count what they did. If they did not, we did not count their no shocks and conducted our own working towards the medical TOR which is also covered in the Summary of Changes document.

The question on ASK MAC seems to say if we trust the responders we can count everything I was hoping for a clarification that can be searched when the question comes up again.

Question: The Opioid Medical Directive allows for Naloxone to be administered 0.8mg SC/IM/IN and 0.4mg IV. The IV route allows the paramedic to titrate to restore the patient's respiratory status. Can this titration also be applied to the SC/IM/IN?

Question: A couple questions with regards to D10. We have used D10 a few times now to treat hypoglycemia and have noticed some issues. It seems that for anyone with a BLG that is very low (say less than 2.0 for argument sake) the max dose of 10g will not get them over 4.0 mmol/L. Is there plans in the future to increase the dose? Perhaps something like if the patient is < 2.0 mmol/L then a 20g max or 4ml/kg loading dose followed by a 10g or 2ml/kg maintenance dose if necessary?

Second, with regards to Buretrol administration of D10, the process is very slow. Both the setup of the Buretrol and the infusion take quite a bit of time obviously more so if a second dose is required. Is there any reason a 60ml syringe can't be used (draw up and push 60cc and follow up with 40cc) as a push administration instead of the Buretrol? For most situations the slow drip is okay but in the case of an agitated or aggressive patient the quicker option would be nice. I realize the benefits of D10 over D50 in not sky rocketing BGL but the way it is laid out now seems that we have gone too far the other way in not raising BGL enough.

Question: My question is in regards to the moderate to severe allergic reaction and medical cardiac arrest. With the new changes, the moderate to severe allergic reaction directive allows us to administer 2 doses of epinephrine q 5 minutes to a max of 2. If a patient were to go into cardiac arrest due to anaphylaxis (after already administering 2 doses of epinephrine), are we still able to administer another dose under the medical cardiac arrest directive? (Leading to a total of 3 doses).

Question: Are paramedics in Ontario authorized to adhere to a person's DNR wishes documented on a completed 'CCAC Plan of Treatment' as an alternative to a completed 'DNR Confirmation Form’?

Question: Although very rare, how should Paramedics manage a uterine inversion?

Question: Can we draw up D10 in a 50cc syringe and administer it that way instead of going through the Buretrol?

Question: If we are presented with a hypoglycemic patient that demonstrates signs and symptoms of a TIA/CVA (slurred speech, inability to hold arms/legs up or due to confusion a grip test) and once the hypoglycemia is reversed with treatment and those signs and symptoms are gone, can we now deliver Ibuprofen/Acetaminophen or Ketorolac if the patient complains of CA related pain or muscle strain as per the Adult Analgesic Protocol?

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: With the introduction of commercial tourniquets and hemostatic dressings for Soft Tissue Injuries/Uncontrolled bleeds in the BLSPCS 3.0, where does the OBHG and MOH stand on wound packing for hemorrhage control? It is generally accepted among TCCC guidelines as a part of basic hemorrhage control, and even taught as a part of First Aid with some organizations. Unfortunately the BLS 3.0 (or 2.xx as well) do not explicitly mention it as an option, as well it is technically prohibited under the Registered Health Professions Act which lists "Putting an instrument, hand or finger, into an artificial opening in the body" as a delegated act. Is this something that we will see added to our scope in the future? Why or why not?

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