Category Archives: Miscellaneous

Category: Miscellaneous, Adult Analgesia, Moderate to Severe Pain, Pediatric Analgesia   |   Date:

Question: Is there any chance we will start giving acetaminophen to children with fevers (a temperature above 38 degrees) in the future? If not, what are the reasons why we can't add this to our protocols?

Category: Miscellaneous, Opioid Toxicity   |   Date:

Question: On February 21, of this year the London Free Press had an article stating that the Middlesex London Health Unit plans to roll out naloxone kits to the public in hopes of preventing deaths from unintentional overdoses. Toronto Health Unit has already been distributing these kits. Why are Primary Care Paramedics still without this drug when Naloxone now in the hand of the public?

Category: Miscellaneous   |   Date:

Question: In the thermal burns webinar very near the end, mention was made of London Fire carrying an ointment for treating burns. If Fire had not applied this prior to a paramedic taking over care for the patient, could the medic allow the ointment to be applied or apply it themselves? Or would this fall out of our scope of practice because such treatment isn't mentioned in the BLS or Medical Directives?

Category: Miscellaneous   |   Date:

Question: Here is a question that has been up for debate from a few paramedics I work with. If you have a penetrating trauma, either in the chest or back, the BLS states to immobilize the object and transport to the best of your ability.

If the patient were to go VSA and the object was impeding CPR, either from the chest or back (not being able to do proper compressions), it was my understanding that we as paramedics are supposed to remove the object if we cannot do proper CPR instead of working around the object, which is the counter argument. What is the direction regarding this?

Category: Miscellaneous   |   Date:

Question: I am seeking direction in the management of a patient(s) who have sustained exposure to Hydrogen Sulfide (H2S) in suicide; taking into account the presenting HAZ-Mat situation and the associated dangers to 911 allied agency personnel. Specifically, assessments, resuscitation, TOR, field pronouncement, transport guidelines and recommendations.

My major concern is the potential harm to transporting crews due to external ventilation of the lethal gases notably if the Fire Dep't "4 Gas Monitor" monitors indicate a presence of H2S.

Category: Miscellaneous, Intravenous and Fluid Therapy   |   Date:

Question: A hospital wants to send a hip fracture patient for transfer. They claim blood pressure is normally high 80's and doesn't require an escort. Should they not still be sending one?

Category: Miscellaneous, Medical Cardiac Arrest   |   Date:

Question: Can ALS take a pronouncement from the on-scene doctor at a retirement home? I ran the code, since the patient was full code, and got a pronouncement on the phone with the BHP. Once we stopped care, the guy who had been watching us, said that he was her doctor and didn't think we would get her back.

I was wondering if that the on-scene doctor had said something at the beginning of the call, could I just ask him for the pronouncement instead of waiting for the BHP to come to the telephone? We cleared it with management to leave care with that doctor since police didn't come to the scene to call the coroner and take over. Otherwise we would wait for police until we left scene.

Category: Miscellaneous, Intravenous and Fluid Therapy   |   Date:

Question: If an IV certified paramedic with a non-IV certified partner initiates a saline lock but does not give fluid or medication; can the partner without IV certification attend the call?

Category: Miscellaneous   |   Date:

Question: I recently did a transfer with a physician going to LHSC University Hospital with a confirmed subarachnoid bleed. The patient was conscious, conversed and was oriented x 3. They were mildly lethargic, c/o an occipital headache with no neuro deficits. The physician accompanied the patient to give a medication to keep the BP on or around 140 systolic.

During transport, the patients BP began to rise to 160-180 because of nausea and vomiting. Gravol was administered and a drug (sorry, I can't recall the name).

He asked me if we carried anything that could drop the BP. He suggested Nitro. I know this is not listed as a contraindication but would it be wise to give a vaso dilator to a patient with a cerebral bleed. We did not administer nitro, but the question still remains. Thanks in advance.

Category: Miscellaneous   |   Date:

Question: I think a lot of paramedics have trouble telling the difference between pulmonary edema (CHF) and bronchoconstriction now. If we had capnography nasal sensors, you could see that the wave form is still flat on top for the CHF while the bronchoconstriction has the shark tooth pattern. This could be a good tool for all paramedics to learn pulse ox without capnography. It is like looking at the heart rate with out and EKG. This should be taught to all paramedics, what do you think? As of now we do not have the nasal sensors, only the ET hook ups.

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