Category Archives: BLS Patient Care Standards

Category: Stroke Bypass   |   Date:

I have a scenario that happened and would like to know what the right answer is. We had a patient feeling generally unwell and dizzy. I performed a stroke assessment and he had equal grip strength, no pronator drift, and could raise both of his legs. There was no facial droop, slurred speech, or unilateral weakness. When we were transporting we noticed the patient was severely leaning to the right. He couldn’t support himself upright at all, but everything else remained intact. Is this enough evidence to count as unilateral weakness? Would you stroke bypass?

Category: Miscellaneous, Trauma Patient   |   Date:

This is a BLS question. For management of a flail chest, most research suggests that we tape the flail segment in place with a large bulky dressing, bag of saline, Asherman chest seal, etc. I've been hearing from recent PCP graduates that they have been taught to use a bulky dressing, however they mention that they are being taught to do a circumferential wrap around the chest with a triangular bandage or blanket to hold the dressing in place (which I would assume is incorrect) instead of taping a bulky dressing over the flail segment. What would be the preferred method and why?

Category: Stroke Bypass   |   Date:

Hello! Question for you. If we have a patient who is complaining of unilateral weakness or numbness, but on exam has equal grip strength, no facial droop or slurred speech, and equal strength in both legs, what would be the appropriate destination? Should we still stroke bypass to the nearest stroke center? To clarify, the patient feels as though they have weakness or numbness on one side of their body, but we are unable to find any deficits on our physical stroke exam (LAMS score of zero).

Category: BLS Patient Care Standards, Medical Cardiac Arrest, Pediatrics   |   Date:

Under clinical considerations medical cardiac arrest, plan for extrication and transport after 3 analyses. For Pediatric arrest would we do 3 analyses and go or complete 3 on scene and 4th before departing in ambulance?

Category: BLS Patient Care Standards, Pediatrics   |   Date:

The ALS PCS shows specific suction settings (based on age) for tracheostomy and ETT but what about for oropharyngeal suctioning? We’ve all been taught the values in school but I can’t for the life of me find a specific and reputable reference.

Category: Stroke Bypass   |   Date:

I recently attended a CVA/TIA related call; it had been the first CVA related call I had been to since having a 4-year hiatus out of the trucks. Since being out the trucks the CVA consult/bypass protocol has been implemented. I'm having a difficult time understanding the point of the consult. If the Paramedic on scene is able to identify CVA symptoms accurately/appropriately, why are we delaying transport to discuss with a physician, who is not on scene, if we should transport to the appropriate stroke facility? It was explained to me that Paramedics weren't correctly identifying CVAs pre-hospital. If that's the case, those that aren't recognizing a CVA aren't performing a consult because they didn't recognize the CVA in the first place. If I can identify a CVA correctly, announce a code stroke to dispatch, and have the stroke team ready on our arrival, how can there be any benefit to calling someone who knows nothing about the incident other than what I tell them? What is the difference between a doctor incorrectly identifying the CVA over the phone versus the Paramedic incorrectly identifying the CVA on scene other than the 15 minutes saved not trying to call for a consult? There also seems to be some significant discrepancies as to the onset of symptoms time frame between different receiving hospitals and physicians. Our destination guidelines clearly state within 6 hrs of onset of symptoms; however, recently a fellow medic advised me that it was 8 hrs but our guidelines have not yet been changed to reflect this, and a physician told me the window is 12 hrs. Any clarification/suggestions/info would be greatly appreciated. Thank you so much!

Category: Stroke Bypass   |   Date:

What is the rule for stroke bypass when symptoms resolve on scene? It doesn’t specify for this scenario in the directive, and only says “continue to bypass if symptoms resolve on transport”. In this case our patients had stroke symptoms for 1-2 minutes that quickly resolved and he no longer had any symptoms. What is the most appropriate hospital in this scenario?

Category: Hypoglycemia, Immobilization, Trauma Patient   |   Date:

I have a question in regards to the hypoglycemia directive. We were dispatched to a patient who suffered a fall, with history of diabetes. Upon assessment the patient was GCS 15, answering questions appropriately and oriented to person, place, time and event, however the patient was unable to move their limbs, and had loss of sensation in portions of the arms, torso, and legs, as well as a depressed skull fracture. The patient was hypovolemic and hypoglycemic at 3.2, stating he has not been eating or drinking fluids all day. Due to a complaint of back pain and paralysis, the a c-dollar was applied and scoop was used to extricate. Because the patient was secured to the stretcher supine, treating with oral gel was not an option, and transport was a priority. Some of the symptoms exhibited by the patient are concurrent with typical signs of hypoglycemia. In this situation where the patient is NOT altered, but hypoglycemic, with sufficient suspicion to suspect that low blood sugar may be causing some of the symptoms, would it be reasonable to treat the patient with IV dextrose? How do we proceed in situations where patients may be hypoglycemic, are not altered (GCS less than 15) but are unable to tolerate oral glucose or carbs? I can see this being the case for traumas.

Category: Do Not Resuscitate (DNR)   |   Date:

Can you assist ventilations when a patient has a DNR? I had a call recently where a patient had a DNR, she was GCS 6, breathing spontaneously at a rate of 20 but there was very little air movement and an O2 sat in the low 80's after we put her on a high concentration mask. I decided it was appropriate to assist her ventilations with a BVM to try to push oxygen deeper in her lungs. This did seem to help because when we arrived at the hospital she was now opening her eyes spontaneously, had a GCS of 10 and her O2 sats got to low 90's. I just want to clarify the difference between assisted ventilations and using a BVM for resuscitation when it comes to DNR's.

Category: BLS Patient Care Standards, Pediatrics   |   Date:

For pediatric VSAs, at what heart rate do we initiate compressions?

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