Author Archives: SWORBHP

Question: When arriving at a scene that turns out to be a ROSC, say Fire applied two shocks and now patient is alert and oriented, and fire pads are not compatible. Do we apply monitor electrodes, defib pads or choose based on our gut of how unstable the patient looks and might re-arrest? Having chosen and justified on the remarks section, what would you like to read to feel we were justified?

Question: This question is similar to one already answered but slightly different. If you have a VSA patient as a result of a FBAO and the obstruction is relieved, should you analyze right away or continue with a 2 minute block of CPR. Also, after having done the medical defib protocol does this patient now qualify for a Medical TOR?

Question: At a meeting with Dr. Lewell in the past, he stated that there is no time set for the administration of medication. Some medics are directed by their services to deliver the medication within 5 minutes and yet the Base Hospital directive asks to have the monitor on in 5 minutes. Medication cannot be delivered without the monitor being applied, so is it correct to say that the time limit is not 5 minutes, but ASAP after the monitor is applied?

Question: I have heard paramedics inquiring amongst fellow paramedics about the use of epi without a cardiac monitor applied or a full set of vitals when dealing with a patient who is suffering from anaphylaxis. My stance is that all meds (except ASA) require a full set of vitals and the cardiac monitor applied. Please clarify.

Question: When a hospital is on "consideration" and we are not accepted by this particular hospital due to their CTAS score or related clinical condition and they are to deteriorate while en-route to the next receiving hospital. What liability do we as paramedics wear in these situations?

Question: For STEMI Bypass, what is the delay in extending the bypass into all of the services that would meet the transport criteria? Originally I was told it was an issue of having an IV established, now with the increasing number of service providers with autonomous PCP IVs this would no longer seem to be an issue. I never understood the initial rationale since say Glencoe is 50km from UH and St Thomas is roughly 20km closer. Yet Glencoe could bypass and St. Thomas couldn't. Thanks in advance.

Question: In a hypothermia patient, what is the reason behind the possibility of them going into A Fib?

Question: With regards to the CPAP protocol, one contraindication is a tracheostomy. If this was just temporary and the tube had recently been removed, would CPAP be able to be administered?

Question: In a PCP crew with one of those PCP IV certified, should the PCP IV attend on all VSA's? All chest pains with nitro use? It's just that the IV directive is very vague and leaves it very open to interpretation. Thanks in advance!

Question: ALS paramedics have directives as to when they must attend/start IV's to give meds in various situations/bolus etc. The directive for starting an IV is for the "potential need" for an IV, administering meds or bolus. Are there specific times we should always attempt an IV if time permits? (pre arrest, post-ictal, chest pain with past nitro use etc?)

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