Category Archives: Medical Directives

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?

Question: If a patient is presenting with signs and symptoms of hypoglycemia (confusion, diaphoresis, pallor, tachycardia, etc.) and you find them with a BG of 4.5mmol/L, but family on scene states their normal BG is over 12mmol/L, and that they are presenting as they typically do when their blood sugar is low, AND you cannot identify from assessment/history any other reason for their current presentation, is it advised to give them oral glucose at this point if they are able to swallow?

Question: Some years ago during a recert in the fall a question was posed regarding administering a nebulized treatment of ventolin to a patient who otherwise would not tolerate an MDI but also had a fever above 38C (all other conditions met). The question was answered by stating if all attempts fail for use of the MDI, a nebulized treatment could be administered if all droplet precautions were taken (N95 worn, gown worn closed window to cab area, goes without saying truck disinfected). Is this in fact the case?

Question: In reference to LOA and gravol administration: a patient who has had a fall and struck their head, has a GCS of 14 (4,4,6) and is alert to person but not place and time, confused about previous events, but can follow commands and is answering some questions appropriately (ie... Birthday, wifes name). Does this rule them out for gravol? My concern is if they are nauseated and we dont treat it early, vomiting and being supine on a spinal board can be very difficult to manage by yourself. I appreciate the definition of LOA is a GCS less than normal for the patient. Can you explain the reasoning for this condition?

Question: I was faced the other day with a question by one of my fellow peers in regards to the administration of nitroglycerine. As a contraindication, it states that we cannot administer nitro of the SBP drops by one third or more of its initial value after nitro is administered. This can be interpreted in 2 different ways, as brought to my attention by my fellow peer so now ever since, I second guess myself. So my question is, this "initial value," is it the very first BP we take even before the first dose of nitro, or is it referring to the initial BP you take AFTER the first dose of nitro. It is such a simple answer I am sure but if I can get clarification so I can also relay the message to my fellow peer that would be great.

Question: Is daily, low dose ASA considered towards 'NSAID use in the past 6 hours,' as per the Adult Analgesia Medical Directive?

Question: I had a scenario where my patient stated he had a few drinks and was slightly drowsy, he answered all my questions fine and was alert to person place and time, once in the ambulance he became nauseous and began vomiting two emesis bags full, I gave gravol in this situation after listing off the contraindications and patient confirming there were none. My question is, would this have been acceptable?

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