Category Archives: BLS Patient Care Standards

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?

Category: BLS Patient Care Standards, Immobilization   |   Date:

Hello, question regarding cervical collar application. The BLS states that a collar should be applied with appropriate MOI if the Pt is altered LOC - however the Canadian Cspine flow chart states that cervical collars should only be used on stable, ALERT Pts. Is this a grey area where it is expected we use our judgement in terms of when it is appropriate to apply a collar vs manual cspine management? Or is there a certain GCS where manual cspine management is preferred over applying a collar? Thank you.

Category: BLS Patient Care Standards, Medical Cardiac Arrest, Do Not Resuscitate (DNR)   |   Date:

Should I ask for a DNR in every scenario where I may use what's contraindicated? If I were to show up for an unconscious but not VSA female and her husband is on scene and doesn't mention the DNR, should I assume they want treatment and continue with inserting an OPA and bagging if necessary or should I ask for a DNR before starting treatment? Would I get in trouble in this scenario if I treated this patient without the husband saying anything and then once we got to the hospital found out they had a DNR?

Category: BLS Patient Care Standards, Oxygen Therapy   |   Date:

Hello, two questions. 1. If I am bagging for a patient in respiratory distress but they do not have a supraglottic airway in, how would I measure their end tidal? Will just attaching my end tidal to the bvm without that same seal provide an accurate reading? 2. If I am assisting ventilations via BVM for a COPD patient who is in respiratory failure should I be concerned about their SpO2 going up to 100? Our current BVM's don't have a way to adjust how oxygen they are getting. I don't want to make my COPD patients hypercapnic by delivering too much O2.

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

Good day, forgive me if I’m mis-reading this, but CPER digest Oct 2021 just published an info-graphic suggestive of staying on scene to run a complete 4 analyses in the case of a pediatric cardiac arrest with a suspected cause/history which is highly suggestive of hypoxia/respiratory in origin. The rationale that they’re presenting is that you’ve got an arrest where CPR and artificial respirations are our best bet for reversing the cause of the arrest. Any discussion related to this? I believe that our current SWORBHP directives are to depart after 1 analysis for a suspected reversible cause of arrest, (unless the rhythm is shockable). Thanks for any clarification that you can provide.

Category: BLS Patient Care Standards, Immobilization   |   Date:

Curious. Obviously, the previous standard for spinal injury was full immobilization on a spinal board. BLS v3.3 currently states that those with suspected unstable pelvis should be secured onto a spinal board or breakaway stretcher (Scoop). We are then being referred to the blunt/penetrating trauma standard. There it also states to secure onto a spinal board or breakaway stretcher, and secure the lower extremities to reduce further injury/trauma to the pelvis. My question is, what is the current acceptable standard for this immobilization as per SWORBHP. Should this be full immobilization, 4 straps, headlocks etc? I do not see this written anywhere, and just looking for clarification as no one I ask seems to know the answer. Thanks

Category: Cardiac Ischemia, STEMI Bypass   |   Date:

Would the presence of De Winter T waves be enough to transport the patient to the cath lab. I know its considered a STEMI equivalent but there is no actual ST elevation.

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