Date Archives: 13-May-2014

Question: My question is regarding our chest pain protocol. There is a 48 year old male complaining of chest pain. It is substernal, 7/10, onset 1 hour, provoked at rest, radiates to left arm sitting steady.

O/E patient's history is hypertension; vitals H/R 78 regular and full; breathing 20x / minute; B/P 138/99; conscious and alert x 3. Patient is not allergic to ASA, so he receives ASA.

History of nitro is in question. The patient states he was in hospital once with similar chest pain and doctor "gave me a spray of something for my chest pain". When asked if it was nitro, the patient did not know name of medication.

Could this patient receive NTG or should we patch?

Question: I am just curious as to why SWORBHP or MAC has opted to pull the android/iPhone medical directives app? This was a great tool if a quick refresh was needed while en route to a call. I realize we should all know our protocols inside out, but sometimes a quick reference for reassurance is needed. I was under the impression when the app was pulled it was perhaps for a further refinement/usability and we would be seeing it again soon. It makes no sense that a tool like this was given to us then pulled back. Also, it's a great tool for SWORBHP to update any protocol changes from year to year as you are no longer supplying us with books.

Question: With the new PCP pain medical directives, I realize there has been a lot of debate over the age range. That being said, if we end up with a patient outside the age range (within reason), in severe pain, who does not meet any other contraindications, if a BH patch would be advisable for the possible administration of ketoralac? I realize that the patch orders are generally doctor specific but I was just unsure if these ages are set in stone or given special circumstances and orders if the rules can be bent. Thanks for the help!

Question: Couple of questions regarding the Musculoskeletal pain protocols:

To be clear, we are to give Acetaminophen and Ibuprofen OR Ketorolac. There is no case where we can give all 3 medications, as Ketorolac requires NPO?

Also Cardiovascular Disease means anyone with any hint of HTN, Athersclerosis, Dysrrhthmias, Heart Failure, and Peripheral Vascular issues, anything of the sort are not to get Ibuprophen?

And lastly for Ketorolac, is a daily ASA considered anticoagulation therapy?

Question: Are there contraindications for sager applications?

Question: I have a question regarding an MCI scenario. There is a total of 10 patients; 3 patients are dead from trauma and 7 patients are cleared off scene from other ambulances. You now have the 3 black tag patients left. Do we need to re-assess these patients and get trauma TOR for each one?

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?

Question: Trauma and BGL. Is it imperative, at a traumatic event, when no signs of hypoglycemia where evident (e.g. guy on a bike hit by a car) to do a blood glucose reading even when a decreased LOA is present. Generally, does stressful events such as this not trigger a sympathetic response which would elevate the reading anyway? I understand if someone was acting different prior to such events. If BGL reading is to be done, when would the MAC feel it most appropriate to obtain, immediately or after package and in the truck? Thanks.

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?

Question: I have a question regarding the Analgesia and Moderate to Severe Pain medical directives for torodol and narcotics. Can a narcotic analgesia and torodol be administered to the same patient on the same call if the ACP determines the patient's pain is severe enough and the properties of both analgesics would be beneficial given the situation? Or are we best to pick the most appropriate analgesia and possible consult with a BHP? Thanks for your time and input!