Category Archives: BLS Patient Care Standards

Question: Just some clarification in regards to DNR's. If a patient is having an episode of an exacerbated Asthma and has a valid DNR, do we administer Epi for the asthma? I understand that we cannot "bag" the Patient due to the DNR status.

Question: With these new medical directives, I was under the impression that we as medics are able to use our judgment and discretion on calls. It is mine and many of my colleagues opinion that oxygen is not required on all calls, maybe even some calls when you provide sympatientom relief, depending on the circumstances. Does MAC agree? Or should oxygen be applied to most patients, and in all cases that sympatientom relief is provided?

Question: I am a recent graduate and have a question regarding the traumatic VSA protocol. We arrive on scene to find 5 patients. Two are VSA and three are CTAS 2. The next ambulance is 5 min away. We use triage but after the three CTAS 2 patients are gone what do we do with the 2 VSA patients? Are we to do a Trauma TOR? Or is it just left at that point?

Question: I have recently received an ACR audit, and have spoken to others, within my service, who have received audits as well, stating that a DNR patient who has not arrested should be ventilated via BVM. Everyone is under the impression that a DNR patient should not be bagged. I know that I have had previous conversations with SWORBHP educators in which the final word on this subject had been no BVM in the presence of a DNR irregardless of whether then patient was VSA or pre-arrest. A similar question on this issue was previously asked and answered on 1-March-2012 with the resulting answer being "therefore, to answer your question, if a valid DNR form is available, none of these "advanced cardiopulmonary resuscitation" procedures should be initiated, period. The SWORBHP medical directors would suggest that this is independent of whether or not the patient has completely arrested or not". The question now is what is the right thing to do? What we have previously been told is right or what the auditors are now saying we should be doing? Could you please shed some light on the situation because there's once again a lot of confusion surrounding the correct application of the DNR. Thanks.

Question: I have some questions regarding supplemental oxygen. For a patient who requires oxygen, but is vomiting frequently is a nasal cannula an adequate oxygen delivery system, or should a Non Rebreather be continually removed an reapplied as necessary? Also I see a wide range of flow rates applied to the nasal cannula (anywhere from 2-8 lpm). What flow rate is most beneficial to a patient in a pre-hospital setting who requires supplemental oxygen via nasal cannula?

Question: We are transporting a patient from a small hospital without a CT scanner to a larger hospital with a CT scanner but not a Stroke Centre. Our patient is an obvious stroke patient...slurred speech for over 1 day, but is getting better and no other issues...stable, but still with slurred speech (does not meet Stroke Protocol as onset over 24hrs).

What should we do should this patient become worse enroute to the CT capable hospital? Say his slurred speech becomes worse or he shows other signs and symptoms? Is this considered a "new onset" or a continuation of his current CVA/TIA? If "new onset" I would think he now meets the Stroke Protocol and should be diverted to the Stroke Centre? Could you please clarify?

Question: For STEMI Bypass, what is the delay in extending the bypass into all of the services that would meet the transport criteria? Originally I was told it was an issue of having an IV established, now with the increasing number of service providers with autonomous PCP IVs this would no longer seem to be an issue. I never understood the initial rationale since say Glencoe is 50km from UH and St Thomas is roughly 20km closer. Yet Glencoe could bypass and St. Thomas couldn't. Thanks in advance.

Question: I don't agree with the transport consideration in case study #1 of the Acute Stroke Protocol that states the patient is excluded from transport to a Designated Stroke Centre due to not being able to determine onset of symptoms: male, age 58, found unconscious on the floor at 0800 by a friend, when he came to pick him up for work.

Shouldn't we consider it likely the symptom onset was < 3.5hrs especially in this case where it would be safe to assume symptom onset probably occurred after patient got up to get ready for work and that he probably does not get up three and a half hours prior to getting picked up at 0800.

Further, it's more likely his GCS would be worse than 10 had he been down much longer. Bottom line, shouldn't we be erring on the side of caution for these patients and give them the benefit of the doubt that symptom onset might be < 3.5hrs given the evidence at hand? Or even with less evidence? As an aside, is the time going to be extended as i believe some doctors think it should?

Question: If we are on a call and suspect child abuse or neglect may be taking place what would be the best way to contact child services? Also could we run into confidentiality problems? An example would be if we are called to a residence for a woman with abdo pains. After assessing the scene we notice an infant sitting next to drug paraphernalia.

Question: The DNR confirmation form states the paramedic will not initiate basic or advanced CPR such as, TCP being one of them. From what I understand, until that person suffers cardiac or respiratory arrest, they are fair game for treatment. So, if a patient is in a 3rd degree block at 20bpm and they have a DNR, we are pacing this patient?

Also, what do they mean on the DNR confirmation form about palliative care? They say we are to provide care to alleviate pain/discomfort such as - NTG, ASA, benzodiazepine, epi for anaphylaxis, o2, Morphine etc. Is this merely an FYI on how to treat a pre-code patient? Clearly the patient would have to be alive to administer these drugs. Again it is said that the DNR does not come into play unless the patient codes. Why is this on the form?

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