Category Archives: Medical Directives

Can you please clarify what I should do if a midwife requests we transport to a different receiving facility as opposed to the closest?

Mom is having a post-partum hemorrhage CTAS 1-2 and there is a stable neonate, can we leave neonate on scene with Dad and call for 2nd unit for baby or can we leave? Do we have to wait until arrival of 2nd unit? No policy on this.

Hello and thank you for your time everyone. Module 2 point 2 reinforces the concept that high quality CPR is the primary focus for care of an opioid overdose VSA patient. However, It also highlights that naloxone may be administered as long as AHA guidelines for cardiopulmonary resuscitation are adequately being met. Given this point; is it o.k. for paramedics to administer naloxone for these type of VSA patients? The directive book and phone application Medical Cardiac Arrest directive continues to state, "There is no clear role for routine administration of naloxone in confirmed cardiac arrest". I found it a little unclear whether this segment was reinforcing the concept to not administering naloxone for a VSA patient, or providing guidance that it is acceptable as long as other aspects of care are effectively delivered.

Do you recommend a c-collar in patients with SGA or ETT in order to help prevent tube displacement?

I have recently read about recommendations/suggestion for the use of the distal femur as an alternative IO access sites specifically in pediatrics. Is this being considered as an option in Ontario?

Slide in conclusion portion of the course, states capnography waveform is gold standard for ETT/SGA tube placement. Previous slide during course states that this has no been studied on other airway except ETT. Can you please clarify this ambiguity.

As far as the LAMS is concerned, when assessing grip strength, what is the score for a pt who has normal grip on one side only?

The current AHA guidelines do not seem to support the use of back blows for conscious choking adults yet this is often taught in Red Cross or St. John courses. Am I mistaken or is there disparity between the current teaching?

Appropriate Discordance Causes STEMI Mimic in LBBB

TOTW: Appropriate Discordance Causes STEMI Mimic in LBBB
Posted on: October 27th, 2021

TOTW: Appropriate Discordance Causes STEMI Mimic in LBBBFrom your 2021 MCME Online module on Bundle Branch Blocks:

Appropriate Discordance is the phenomenon that occurs in Bundle Branch Block, wherein the J-points and ST segment move opposite the direction of the widened QRS complex, due to the change in conduction from the bundle branch block. In LBBB, the QRS complex points downward in the anterior precordial leads, which would mean the J-point and ST-segment are elevated, just by nature of its morphology. This is why LBBB is a STEMI mimic and a contraindication for the STEMI Bypass Protocol.

Check out the 2021 MCME Precourse on Bundle Branch Block for a deeper dive on this ECG finding.







*Please note that only partial tracings are shown here. Please use the T-P segment (not the PR-segment) to measure the isoelectric line.

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TOTW: Management of Uncomplicated Delivery - Delivery

TOTW: Management of Uncomplicated Delivery – Delivery
Posted on: October 13th, 2021

TOTW: Management of Uncomplicated Delivery - Delivery

From the Emergency Child Birth online module:
Steps to deliver when baby’s head is visualizes and birth is progressing:
1. Prepare the patient (see TOTW on Management of Uncomplicated Delivery – Preparation)
2. Guard the perineum with one hand. With the other guide the head out slowly (top left photo)
3. Check for and manage nuchal cord – present in 5% of deliveries (photo on right)
4. Allow for spontaneous restitution/external rotation
5. Apply gentle lateral flexion, followed by gentle upward flexion to deliver the shoulders and body (bottom left photo)


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