Category Archives: Medical Directives

Question: Reviewing the STEMI bypass protocol I noticed that it requires 2mm of elevation in V1-V3 in two contiguous leads and 1mm of elevation in any other contiguous leads.

My question is then twofold:
1. What's different about V1-V3 that we require 2mm of elevation?
2. Why is V3 included in this since it is not anatomically contiguous with V1 or V2? Should then V4 not be included to give a "partner" to V3?

Thanks for your help!

Question: When attending to a medical VSA, where our monitor energy settings are preprogrammed (120J, 150J, 200J, 200J), if I happen to dump the first charge (non-shockable rhythm), should my second charge be at 120J or 150J? This second charge would be the first shock (assuming shockable rhythm), but the second analysis.

Question: Pushing a dose epinephrine seems to be very popular in the FOAM world for emergency physician. Its use has been promoted for things such as post cardiac arrest, refractory anaphylaxis, and severe bradycardia (some strong pharmacology reasons supporting it over atropine have been presented). Is this something you see being added to the advanced care paramedic treatment options at some point?

Question: I am just wondering if ASA is contraindicated for patients taking Pradaxa?

Question: While enroute to the emergency department with a VSA patient, if your patient presents in shockable rhythm (either new, or still in a shockable rhythm), can we continue to shock the patient without pulling over? My understanding of the reason for stopping was because we used to use semi-automated systems, and we did not want false interpretations based on artifact. But, if we are now interpreting the rhythm, and determine that it is a shockable rhythm, not artifact while in transit, shouldn't we be shocking?

The OBHG companion document states to stop when enroute using semi-automated system, no wording on manual defibrillation.

Question: Can you give Ketorolac to a HTN patient (180 systolic)? The PCP directive states Normotension.

Question: In Elgin county we have been having trouble with our defibs spitting out 'noisy data' warnings on our 12 lead ECG's lately which has prompted conversation with crews about the STEMI protocol. Though the protocol clearly states that LP15 ECG software interpretation meets ***MEETS ST ELEVATION... some crews are saying that due to this issue with noisy data, we are able to interpret the ECG on our own and determine if it meets our criteria based on the >1 mm/or the >2mm ST elevation criteria. Your thoughts? Should we patch the cardiologist? Should we transport to nearest ED due to software not recognizing due to noisy data?

Question: We were presented with a patient on scene who stated she had fallen 2 hours prior. The fall was due to a slip on the ice. There was no LOC, no head injuries or any other neuro deficits. The patient’s vitals weren't abnormal and was in a mild state of distress on scene. The only injuries noted were some wrist and knee pain, where there was no obvious deformity or injuries evident but stated both as 7/10 pain. She also mentioned her back was in moderate pain from the fall as well. My partner and I were unsure of whether to provide symptom relief for pain management. Yes there is trauma to 2 different extremities but it was the simultaneous back pain that threw a twist in, as the directive states that the patient must have "isolated hip or extremity trauma." We were minutes from the hospital and I did ask the patient if the pain was tolerable until we got to the hospital where they would provide more effective pain management, but for future reference it would be nice to no! t have to think twice if put in this particular situation again.

Question: The IV Therapy Medical Directive lists hypotension as a required indication for a fluid bolus. In pediatric medicine, blood pressure is rarely used alone as an indication of perfusion and tends more to rely on looking at the overall presentation including: level of awareness/activity, heart rate, capillary refill etc.

If presented with a child who is: irritable, tachycardic (or bradycardic for that matter), with delayed cap refill, and decreased urine output, but is not hypotensive (<5th percentile), is it permissible to administer a fluid bolus?

1 2 3 4 5 6 29