Category Archives: Miscellaneous

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.

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?

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.

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?

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.

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.

Question: I've heard the discussion among crews about allowing certain procedures to be performed on patients while still on EMS stretchers and on delay. I've received conflicting responses. I am perfectly fine with 12 lead, blood samples and going to x-ray while patient is with EMS. I'm not comfortable with any medications being given outside my scope of practice while under my care. Some crews say no "hospital" procedures are to be done until the patient is accepted by the ER. My personal opinion is that is possibly delaying patient care and causing more back up delays in the ER. I've received different opinions by our management. I know MAC cannot answer to service direction but what is the direction of MAC to what can or should be allowed to be performed by ER staff while under EMS care.

Question: Are MOOCs eligible for continuing education (CE) points?

Question: If TCP with Zoll E series, what are the steps to be taken when transferring care to the receiving facility? Procedure to switch to their machine?

Question: Why don't Base Hospital Doctors at either Hospital carry a cellphone so when paramedic's call for a physician patch that call goes directly to them instead of being routed to triage and then to the red phone at either hospital? I have had a couple of calls recently where by the time I was speaking to the Doctor we were almost at the hospital when I got the order. I think this would be a tremendous asset for the medics if we could have this option.

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