Category Archives: Tip of the Week

TOTW: Age Considerations for IM Epi Only for Bronchoconstriction

TOTW: Age Considerations for IM Epi Only for Bronchoconstriction
Posted on: October 20th, 2021
TOTW: Age Considerations for IM Epi Only for BronchoconstrictionFrom your 2021 MCME COVID-19 Considerations precourse module:

Remember that the age condition of <50 years for administration of Epinephrine IM DOES NOT apply to the Moderate to Severe Allergic Reaction Medical Directive.  This age restriction only applies for the Bronchoconstrictive Medical Directive COVID-19 Considerations.

For more information and rationale for  COVID-19 practice considerations, check out the COVID-19 Considerations module on the PPO from your 2021 MCME precourse.

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Management of Uncomplicated Delivery Preparation

TOTW: Management of Uncomplicated Delivery Preparation
Posted on: October 8th, 2021

TOTW: Management of Uncomplicated Delivery Preparation

From the Emergency Child Birth online module:
Preparation for birth (after you have determined it is imminent):
1. Assist patient to a firm, flat surface
2. Patient supine* hips and knees flexed and abducted, perineum visible
3. Provide warmth, ensure adequate lighting
4. Place a plastic bag or sheet, sterile drape under buttocks
5. Wash hands, use sterile gloves

*Suggested optimal positioning. Cannot force mom into this position. If she is too uncomfortable, let her guide what the best position is for her.

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2021 MCME TOTW – Management of Precipitous Delivery

TOTW: Management of Precipitous Delivery
Posted on: September 29th, 2021

TOTW: Determining the Frequency of Contractions

From the Emergency Child Birth online module:

Precipitous Delivery = Birth of a newborn within 3 hours of commencement of regular contractions.

 

Managing a precipitous delivery: Guard the perineum with one hand by putting direct pressure and with the other hand we control delivery of the head so it doesn’t come out as forcefully. Remember to keep the fingers straddled around the fontanels and exert some gentle pressure to avoid a rapid delivery.

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TOTW: Determining the Frequency of Contractions

TOTW: Determining the Frequency of Contractions
Posted on: September 24th, 2021

TOTW: Determining the Frequency of Contractions

From the Emergency Child Birth online module:

Contraction frequency is measured from the START of the first contraction to the START of the following contraction.

Important to know because timing of contractions signals the active/2nd stage of labor, meaning pushing will occur next.

  • Primips (1st delivery) q2-3 minutes
  • Multips (2nd or more delivery) q 5 minutes
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TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)

TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)
Posted on: Sepetmeber 10th, 2021

TOTW:2020 AHA Guidelines Recommends Early administration of Epinephrine (ACP-Scope)

New to the 2020 AHA guidelines is a recommendation for epinephrine administration as early as possible in non-shockable cardiac arrest for both adult and pediatric postulations.

A systematic review and met analysis showed increased ROSC and survival to hospital discharge in those given epinephrine. Observational data suggest there are better outcomes when epinephrine is given sooner.

For more great evidence based recommendations, check out your 2021 MCME Precourse module on the AHA Guidelines Update!

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TOTW: 2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)

TOTW: 2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)
Posted on: February 17th, 2021

2020 AHA Guidelines Recommends IV Over IO (ACP-Scope)

New to the 2020 AHA guidelines is the preference for IV medication administration during ACLS, over IO administration.

A recent systematic review found better clinical outcome in patients that received ACLS drug administration via IV vs IO.

 

Consistent with the current ALS-PCS treatment, they state IO access is acceptable if IV access is unavailable.

For more great evidence based recommendations, check out your 2021 MCME Precourse module on the AHA Guidelines Update!

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2020 AHA Guidelines Recommends Resuscitation Debriefing

TOTW: 2020 AHA Guidelines Recommends Resuscitation Debriefing
Posted on: February 17th, 2021

2020 AHA Guidelines Recommends Resuscitation Debriefing

New to the 2020 AHA guidelines is that recommendation for performance-focused debriefing after resuscitation.

Post event debriefing = a discussion between 2 or more individuals in which aspects of performance are analyzed, with the goal of improving care.

There is evidence that shows these debrief sessions (formal and informal) resulted in improved quality of resuscitation (i.e. Increased chest compression fraction, reduced pause) in future resuscitations.

See more great evidence based recommendations in your  2021 MCME Precourse AHA update module!

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TOTW: Symptomatic Bradycardia

TOTW: Symptomatic Bradycardia
Posted on: May 12th, 2021

TOTW: Symptomatic-Bradycardia

Please remember when treating a patient with Symptomatic Bradycardia:

The patient is required to be:
1.BRADYCARDIC (HR < 50)
2. HEMODYNAMICALLY Unstable (refers specifically to SBP <90)
3. ≥18 years

Please remember the 12 LEAD (as early as possible)!

Mandatory Provincial Patch Point = Required for the use of Transcutaneous Pacing and/or Dopamine!

Treatment Pearls:
Dopamine = Starts at 5 mcg/kg/min titrate SBP to ≥ 90 to < 110
Pacing = start at 80 beats/min and then increase mA until capture (mechanical/electrical) then go 10 mA above to lock it in.

*See the OBHG Companion Document (v4.8.1) for further pearls and considerations regarding this Medical Directive

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TOTW: ALARM Mnemonic for Shoulder Dystocia

TOTW: ALARM Mnemonic for Shoulder Dystocia
Posted on: March 19th, 2021

TOTW: What Information Should You Relay at the Start of a BHP Patch

Early recognition and management of Shoulder Dystocia is key in mitigation of critical irreversible hypoxic injury in newborns.
Remember to watch for tell-tale “turtle sign”, when the head emerges and then retracts against the perineum, due to the shoulder stuck on the maternal symphysis pubis (anterior shoulder) or sacral promontory (posterior shoulder).

Then use the ALARM pneumonic to manage these critical deliveries:

A: Ask for help (You will require 2 people)

L: Lift legs, hyperflex thighs (McRoberts Maneuver)

A: Adduct shoulder (Apply suprapubic pressure

R: Roll over (Gaskins Maneuver)

M: Manually delivery of posterior arm (if visible at the perineum)

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TOTW: What Information Should You Relay at the Start of a BHP Patch

TOTW: What Information Should You Relay at the Start of a BHP Patch
Posted on: March 10th, 2021

TOTW: What Information Should You Relay at the Start of a BHP Patch

Ensuring the following information is relayed at the beginning of a BHP patch:

Full name, Service, Run Number if available, designation and reason for patch (“I am calling for a TOR”, I am calling for an order for midazolam), then proceed into providing details of call.  There is no need to provide an oasis number to the BHP

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