Category Archives: Tip of the Week

TOTW: Treat What You Can

TOTW: Treat What You Can
Posted on: January 14th, 2022

From your 2021 MCME Interactive day:

Treat what you can from a patient presentation.

We taught the Differential Diagnosis algorithm this year to help you generate potential causes for patient complaints. However, you may not always come to a clear cause of a patient’s symptoms.

Despite this, you still have tools in your toolbox to employ! For example, a patient with hypoxia can be treated with oxygen without knowing the exact cause.

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TOTW – Centralized Patching: Only the On-Call BHP Can Give Orders

TOTW – Centralized Patching: Only the On-Call BHP Can Give Orders
Posted on: January 7th, 2022

From the Centralized Patching online module:

Physicians at former patch sites can no longer provide patch orders as they are no longer registered as Base Hospital Physicians. Orders can only be sought from the BHP on-call under the new Centralized Patching model.

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TOTW: Stroke and the LAMS Score

TOTW: Stroke and the LAMS Score
Posted on: December 30th, 2021

From your 2021 MCME Online module on stroke:

The Los Angeles Motor Scale (LAMS) classifies patients based on the severity of their stroke symptoms. Scores ≥ 4 can help predict a Large Vessel Occlusion (LVO) stroke. Optimal care for LVO strokes can only be completed at select specialized stroke centers, within a certain time window. Therefore, identification of these strokes in the prehospital environment, using the LAMS Score, can help get the patient the best possible treatment.

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TOTW: Patch failure: Definition and what to do if it occurs

TOTW: Patch failure: Definition and what to do if it occurs
Posted on: December 23rd, 2021

From your 2021 MCME Centralized Patching precourse:

A patch failure is when you are unable to reach a physician after trying both the primary and secondary BHP phone lines. In these situations, proceed with treatment if the treatment is outlined within the ALS PCS directives (or in the case of cardiac arrest, proceed with transportation) and attempt to establish communication when feasible.

Should this happen, please let us know so that we can examine what happened and try to improve the system. Please document this patch failure on your ACR and complete and online self-report to flag this.

It is reasonable to try the primary line a second time, before attempting the secondary line. Sometimes the Primary BHP cannot answer the phone quickly enough.

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TOTW: Naloxone and Allied Services

TOTW: Naloxone and Allied Services
Posted on: November 24th, 2021

Now that many first responders carry naloxone, remember that paramedics should not ask these providers to administer it.

The direction to administer or prescribe (direct the dispensing of a drug to a person) medication is a controlled act and therefore must be delegated by a physician.  You cannot delegate a delegated act to another care provider. This is operating outside of your scope of practice.

As the highest medical authority on scene, patient care should be provided as per the ALS PCS. Once paramedics have assumed care of the patient, other first responders may assist you in care provision. However, medications are to be administered by paramedics in accordance with the ALS PCS.

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TOTW: Auscultation Pearls

TOTW: Auscultation Pearls
Posted on: November 10th, 2021

From your 2021 MCME Online module on Differential Diagnosis:

Auscultation is an extremely important skill and should be used for (and documented) on all patients with complaining of shortness of breath. Some pearls to remember:
• Listen for a full respiratory cycle
• Ensure the diaphragm is placed on the patient’s skin (do not listen through clothing)
• Utilize a step-ladder approach, listening to both sides of the chest at the same level, before moving down/up to listen to the next level, to allow for comparison

For more pearls check out the 2021 MCME module on Differential Diagnosis.

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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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