Category Archives: Medical Directives

Question: Can you clarify a condition in the contraindications for nitro use protocols? Current contraindications listed under the protocol are self explanatory, where as one to me seems to be very vague. The one I’m referring to is the use of a "Phosphodiesterase Inhibitors" within the previous 48 hours. They are many examples of this type of inhibitor (including caffeine) and it might reduce confusion if the specific and relevant ones were listed under the protocol specific to cardiac. For example, a patient who has had a cup of coffee prior to your arrival or 48 hours prior to for that matter has ingested a Phosphodiesterase Inhibitor. Under the current directive and the way it is written, could be argued that this patient is contraindicated to receive Nitro.

Question: ROSC Protocol states bolus 10ml/kg if under 12 check at 100ml and over 12 check at 250. Cardiogenic Shock Protocol (includes ROSC) -states bolus 10ml/kg -if 2 to 18 check at 100ml and over 18 check at 250ml. One states the 12 to 18 range at 250ml but the other 2 to 18 at 100ml. Can you clear this up for me please?

Question: In our recert course, we were told that ACPs must patch to the BHP after the third analysis (during a medical arrest). Why do we have to patch so early? Shouldn't we patch after three rounds of epi?

Question: When treating a patient with suspected cardiac ischemia, should I acquire a 12-Lead ECG before giving nitro or ASA? If the patient is hypotensive, should I bolus at 20 ml/kg, or 10 ml/kg as per the cardiogenic shock directive? And how do I know if the patient has a right ventricular infarct?

Question: The PCP Medical TOR says that I can "move the patient to the ambulance prior to initiating the TOR if family is not coping well or the arrest occurred in a public place". What is an example of a public place? and if I move them to the ambulance and then get the TOR, is this now the place of death and I have to wait for the coroner to arrive?

Question: With regards to neonatal resuscitation, are we to provide room air PPV for 30sec (as per ALS PCS), or provide room air PPV for 90sec (as per AHA guidelines)? Also, why is room air the preferable choice for initial PPV over 100% O2?

Question: I see that it says consider NaCl bolus in the cardiac arrest standing order. In the past we gave a bolus for PEA as well as Rosc's. Can you confirm the exact circumstances we are to give the bolus as I find there to be a lot of gray areas in our orders.

Question: My question is regarding fluid bolus for DKA. Past practice has been to initiate a BHP patch for direction to administer a fluid bolus. The most recent Provincial Protocol states that a patch is only necessary for DKA in patients under 12. Are we still required to patch for a fluid bolus for adults in DKA?

Question: In regards to the new medical VSA directive: Would CO poisoning leading to VSA be considered an unusual circumstance? Thus performing one analysis and transporting would be acceptable?

Question: If I have a patient that appears to be in cardiogenic shock with a STEMI ECG should I be calling for a BH patch to have an order for aspirin after initiating an IV bolus?

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