Category Archives: BLS Patient Care Standards

Question: This question is regarding not giving Narcan to a DNR patient. Obviously, if there is not an underlining medical issue (e.g. terminal CA) and a patient ODs, even with a DNR, we attempt to reverse any issues. However, if the patient does have a medical issue with a DNR, has decided to OD to commit suicide and is in a pre-arrest / arrested state, is it reasonable to assume that since they are breaking the law, that the DNR can no longer be valid?

Question: If a patient meets the protocol for having CPAP treatment but they have a valid DNR Confirmation Form can a PCP still administer CPAP?

Question: If a patient has a valid DNR, can they still fall under the Stroke Protocol? I realize the protocol's contraindications list a palliative patient or terminally ill but does not address DNR. DNR in my point of view only applies to a patient who is dead, and wishes to not be resuscitated. Treatment for stroke at a proper facility could restore the patient's quality of life if such is affected by the stroke, and I feel they should still be included. I just wanted to verify.

Question: I have a question in regards to a specific situation with the Acute Stroke Protocol. We were called at 06:30 for an 85 year old female in a nursing home with slurred speech as witnessed by nursing staff. Upon our arrival she has a GCS of 15, blood glucose of 6.2 and obvious unilateral facial droop and pronounced associated slurred speech. The patient stated that she was up at 03:00 without concern which removed her from the Acute Stroke Protocol with all other criteria being met.

I understand that if the stoke symptoms resolve prior to our arrival the patient is not eligible for transport under the by-pass protocol. Additionally if their symptoms improve or resolve en route to a Stroke Centre transport should continue. However, en route her symptoms completely resolved and subsequently reoccurred – resolved again and while reporting to triage reoccurred in front of the staff at emerg.

After dialog with emerg staff I have the understanding that with completely resolved symptoms the "clock" would start (for them) with the onset of the recurrent (and witnessed) symptoms.

I would believe she would have the most appropriate care and best outcome being treated at a Stroke Centre. My question is twofold: first, is this a correct understanding of the possible in hospital treatment in way of assessing the initial onset of symptoms? Secondly, specifically for our transport decision could we use the recurrence onset of symptoms as the initial onset for meeting the Acute Stroke Protocol individually if it happened on scene or en route given we had equal distance to an ER or UH?

Question: I am a recent grad from the PCP program and a new hire at my service. I have a question regarding packaging. We were called code 4 for a patient who had a fall. A call from a wrist alarm company.

Patient was found on floor by superintendent in the patient's building after connect care instructed the super. Upon arrival patient was found still sitting on the floor. The carpet behind the patient had a small pool approx. 200mls. Patient cannot remember event but is LOA x 3, good long term memory. Patient does not know how long she has been on the ground.

Physical assessments - Trauma noted on back of head. Lac (bleeding stopped) + Hematoma approx. 1 inch diameter noted on occipital area. Chest is clear, abdomen soft and non tender, pelvis stable, no trauma otherwise noted.

Equal grip strengths. Pupils PERL. Vitals are all within normal limits. Patient upon assessment has no complaints. No dizziness, no lightheaded. NO c-spine, tenderness, no back pain.

It looked as though the patient fell from height, backwards, struck head on dresser and activated wrist alarm. I decided to package the patient as a precaution. I padded the backboard with a towel before laying patient head on the board.

My question is was it necessary to apply collar and backboard this patient? Patient had no c-spine tenderness, no back pain, LOA x 3, good long term memory only issue is patient cannot remember the fall. Patient had no complaint, except the pain from the hematoma against the board.

Question: My question is regarding CTAS with symptoms relief administration. It was my understanding that years ago symptom relief pocket books had an adverb that read something to the effect of " If a symptom relief medication is administered then you should return to the ED no less than CTAS 2". It seems to me there are circumstances that would allow symptom relief to be administered and return CTAS 3 or less. (i.e. Nausea due to flu gravol administered, mild to moderate allergic reactions with benadryl administered...) I had a debate with a peer stating it was their belief that any time SR is administered we are still to return code 4 CTAS 2. I was under the impression as thinking medics we could use some discretion, is this the case or should we always return minimum CTAS 2 in that scenario.

Question: What are your thoughts on oxygen therapy in myocardial ischemia from a medical evidence standpoint? Even though high flow o2 is regularly administered to PTs with chest pain as per the oxygen therapy and chest pain standards in the BLS standards, there is an increasing body of evidence suggesting that in uncomplicated MI O2 is of no benefit and may cause more harm than good due to ROS and ischemia-reperfusion injury.

The recent ACLS guidelines state to only administer O2 in acute coronary syndromes if the spo2 is < 94% or the PT is in respiratory distress or obviously hypoxic and there are several recent papers and clinical guidelines that suggest a similar course of action in uncomplicated MI. Basically, the evidence is suggesting that titration to spo2 is favorable over high flow o2 due to the risk of oxidative stress injury.

Any thoughts? Obviously you still follow the protocols, but I'm just interested to see if there is any medical opinion on this. Could the standards/guidelines eventually change to reflect the newer evidence?

Question: On a recent call, we transported a patient from a nursing home with a valid MOHLTC DNR. In the middle of all the paperwork was a nursing home DNR with level 1, level 2, and there was a check mark that the patient did not want to decide on a DNR status at this time. The MOHLTC DNR was dated in 2009 and the nursing home DNR was dated 2010. Do we respect the valid MOHLTC DNR or the nursing home DNR dated later?

Question: I would like to go back to the DNR ventilation question from Sept 4th. The way I understand your answer is that there is no difference between Assisted ventilations and Artificial ventilations in regards to a DNR; Both are inappropriate if a DNR is present, even if the patient has spontaneous respirations. I am interpreting your answer correctly?

Question: A patient requires assisted ventilations via BVM for shortness of breath for CHF or for exacerbated asthma, can we assisted ventilations for this patient. I understand that we cannot perform artificial respirations for a patient who is apneic, but can we assist ventilations with a patient who is conscious and breathing on their own, but needs assistance? Patient has a valid DNR.

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