Category Archives: BLS Patient Care Standards

Question: My question is in regards when a crew has a positive STEMI result on a cardiac ischemia call. I noticed that on these types of calls there has been incidents where patients have been going in lethal dysrhythmias as crews are trying to deliver the patient to the cath lab. Most recently I was at a hospital and as a crew was entering the elevator the patient went into V-Tach and there was a delay to defibrillating because the crew had to attach the defib pads.

I noticed myself when entering the cath lab the first thing the staff does before even accepting the patient and allowing crews to disconnect the cardiac monitor is attach defib pads. Due to the high mortality rates (5%) of STEMI patients transported by EMS and the time it takes to attach the defib pads when the patient enters the lethal rhythm, would it be wise to attach the defib pads on positive STEMI patients during transport(even though they have not gone VSA) to decrease the time to defibrillated the patient if in fact the patient enters the letahal rhythm.

Question: You are called to a retirement home for an 85 y/o female for a possible CVA. On arrival you are met by a Nurse Practioner who stated patient is having a stroke. Nurse Practioner also states that patient (who is a retired RN) has talked to her family doctor who agrees with patient's decision of not wanting to go to stroke centre or stroke protocol done. Patient has history of heart. Assessment reveals patient alert, orientated x 3 and meets stroke protocol. Patient wants to be transported to the local hospital for assessment. Does this patient or any patient have the right to refuse transport to a stroke centre?

Question: With respect to use of an OPA, I have had discussions with coworkers who always will insert one with an unconscious patient. Is this proper? My argument is, even the MOH literature seems to state that 'less invasive' airway management such as positioning, suctioning and constant monitoring of the airway is acceptable. Some common situations of this would be a post-itcal or alcohol intoxication persons. Thanks.

Question: I was just wondering if we have a patient with a valid DNR are we still allowed to Bolus if they fit our protocol or is this considered an advanced life saving technique?

Question: I recently did a call in which the patient was found by nursing home staff to be agitated and non-verbal with left sided arm paralysis. On EMS arrival the patient was moving all limbs but was still non-verbal and agitated. I also noted LT side neglect and some LT side facial drooping. The patient was last seen in a normal state at 04:30 and the time of our arrival was 08:30. The patient also had a valid DNR and I confirmed again with the POA on scene that it was still the wishes. By the time we loaded and transported the patient was outside the 4 hour mark for any CVA treatment. I returned to patient CTAS 3 as they were outside the time line and for the valid DNR. I am wondering if the patient had been within the 4 hour mark for treatment should this patient be returned CTAS 2 or would they still be CTAS due to the DNR? Thanks.

Question: I had a call today to a nursing home where the patient had a valid DNR. The patient was in agonal respirations. The staff stated the patient HAD to be transported to ER as per direct orders from the doctor on call for the nursing home. She kept saying the patient was a level 3 and he had to go to ER. My partner and I told the staff we cannot do anything for him and with a valid DNR the patient does not need to be transported. The staff argued with us more saying the patient had to go and that they already called ER. Instead of getting into it further with staff my partner and I loaded the patient and went to ER. We transported Code 3 as the patient expired as soon and we left for ER. Were we right in doing so? I pre alerted ER about the situation and they were accommodating when we got there.

Question: There is certainly a lot of confusion that remains in regards to DNR's. From your replies, I get the impression that if someone is breathing, has a pulse and a valid DNR, but has respiratory or cardiac problems which may or may not be corrected with artificial ventilation, assisted ventilation without an artificial airway (conscious CHF)or chest compressions we are to provide NRB O2, symptom relief meds and comfort measures. That being said, if someone has a valid DNR becomes obstructed with a FB, we have been instructed by BH personnel to attempt to clear the FB and if death results in the process, validate the DNR and stop the efforts. If this is correct, are we not providing or at least attempting to provide A/R in one of the steps to alleviate the obstruction? This would be in contraindication to past answers which the committee has provided. Not trying to be a pain, just looking for clarity for viewers and myself. Great site – your time and effort is appreciated.

Question: I like to give O2 to patients for pain (when not contraindicated) even if their stats are good. I have done this for years and have found that it seems to help. A fellow paramedic felt that this was a very useless application. I disagreed. I have looked for scientific evidence for this working and have found little on it. I was wondering if you would comment.

Question: Recently I had a call for a 2 year old anaphylaxis that I ended up treating with epi and ventolin. The patient was very short of breath and had a decreased LOC and ended up having to be ventilated. Eventually the patient came around with the epi and the bagging. This patient's heart rate was approx. 70/min. My questions is, are we still starting CPR on pediatrics with signs of poor perfusion with a heart rate of less than 60 or is this just for neonates?

Question: Patient is unconscious respirations of 8 but DNR is present. We can't assist respirations using a BVM? Sorry if this question had already been asked / answered.

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