Author Archives: SWORBHP

Question: I was talking to an ACP who informed me a standard of care I had not heard of. He told me that all Obstetrical patients who have a syncopal episode should have a 12 lead done. He also said that 12 lead can be done pretty much on anyone. I was under the impression that 12 leads were to be done on patient's with chest pain. or symptoms consistent with ischemia. From what he was saying I was getting the impression that we should be doing 12 leads on most people to rule out any underlying cardiac conditions.

Question: For a patient with fluid building up in the lungs (recently having the same issue and having to have fluid drained via chest tube) due to a complication of CA, what is the best course of action? It wouldn't seem that a bronchodilator wouldn’t be effective and since the fluid is of non-cardiogenic nature would nitro work?

Question: In regard to the new Acute Pulmonary Edema protocol and the confusion surrounding it. Are we really giving 0.6 to 0.8 mg of Nitroglycerin SL to a patient with no IV and an Hx of use and a SBP of >140 mmHg?

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: In performing your ABCs on unconscious patients, the BLS has never clarified whether, after checking the airway you should, insert an airway then go to breathing OR go to breathing, insert 2 breaths, then insert an airway. Can you finally put an end to this debate?

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

Question: If you get a ROSC on scene, after one analyze, patient rearrests enroute, can we pull over and finish the protocol? One analyze or three?

Question: Recently, after transporting a stroke bypass patient we were told they could not be treated for the stroke (with thrombolytic) due to the patient's history of warfarin use.

How does this fall under our protocol but outside theirs? If blood thinners (either in conjunction with a specific disease or as a certain dose) are a roadblock to thrombolytic therapy why isn't it listed as a contraindication to the bypass protocol? We did not have time to discuss the rationale behind the statement and have been wondering since if we misinterpreted the statement or if warfarin and similar drugs really do prevent thrombolytic use with CVA's? I know there have been studies linking problems with tPA in patients with warfarin history but didn't know that played an active role in the exclusion criteria at stroke centers now. If this is the case why not change the protocol to eliminate needless transport (especially when transporting from outside of the city/county where the center is located?

Question: On our ROSC protocol, the ONLY route that we are allowed to give a fluid bolus/dopamine is via an IV. Please confirm that we are NOT allowed to do so via IO or CVAD? This does vary from the IV and Fluid Therapy protocol which allows us to do so.

Question: Can you explain what this part in the consent section means? It seems to give more flexibility to not begin resuscitation based on family members who seem reliable saying that that is what the patient wanted. "If a paramedic is aware or is made aware that the person has a prior capable wish with respect to treatment, they must respect that wish (for example, if the person does not wish to be resuscitated)."

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