Date Archives: 11-Oct-2012

Question: I am a current PCP taking ACP. I was recently informed, during an ACP class, that on an unconscious CHF patient, nitro can still be administered if vitals are within normal range and the other conditions are met. When I checked the protocols, under conditions, it states that LOA: N/A (whereas for cardiac ischemia, the LOA must be unaltered). However, it seems to me that if the patient is unconscious, the patient is too unstable to receive nitro. I have never experienced a call like this, and it would seem that in most cases an unconscious patient would have vitals outside the perimeters of nitro administration. Can you please verify this? Thanks

Question: I have a question about a call. Male patient severe SOB. Crackles throughout with a GCS of 4, suspected acute pulmonary edema. Obviously patient of out nitro protocol. Patient's spo2 31 and 42% with mottling noted. Patient's initial pulse 42 with a respiration rate of 33. CPAP is contraindicated at this time so ventilations assisted via BVM. Enroute patient's GCS improves to 15 and spo2 increases to 99% with ventilation assist. At this point could CPAP be applied or is it like the nitro protocol, once your out your out?

Question: Just would like clarification that we "must" attempt an IV on all seizure patients first before moving on to either IM, IN, Buccal. The chart is written in this order. I feel that attempting IV's on a lot of our seizure patients could very easily pose a safety hazard on ourselves and others in the field. Thanks.

Question: I would like to go back to the DNR ventilation question from Sept 4th. The way I understand your answer is that there is no difference between Assisted ventilations and Artificial ventilations in regards to a DNR; Both are inappropriate if a DNR is present, even if the patient has spontaneous respirations. I am interpreting your answer correctly?

Question: Recent call of a 40 years old woman with a past history of renal colic and experiencing intense low back pain that she likens to an exacerbation. She is a small woman at about 45 kg and a candidate for narcotics under the standing order for pain relief. Two questions: Firstly, we were unable to establish an IV after 2 attempts and the standing order specifies only the IV route of administration. Can morphine and/or fentanyl be given IM in this instance as a standing order? Secondly, her initial BP was 90/60. Given the patient's size and her statement of usually having a low BP, can this reading of 90/60 be considered as normotensive? What if it was 85/60? Thanks in advance for your answer.

Question: I have noticed a number of paramedics do blood glucose testing based on the hx of an event and not how the patient is presenting at the time of assessment. For example - hx of fainting, period of unresponsiveness, diabetic with N/V, etc. If the patient is not presenting with any of the indicators outlined in the hypoglycemia protocol should we be testing the patient’s blood glucose levels?