Date Archives: 17-Dec-2015

Question: If a pediatric patient is significantly larger than expected (for example, a 6 year old female who weighs 120lbs), do we still use the pediatric dosing chart OR calculation OR adult settings? Personally, if I'd done this call today, I probably would have chosen to use the pediatric calculations of 2J/kg then 4J/kg etc.

i.e.: If using peds dosing chart, this 6 year old would only get a shock of 50J 100J 100J 100J

i.e.: If using peds calculation, she would receive 110J 220J 220J 220J

i.e.: If using adult settings, she would receive 200J 300J 360J 360J

Question: If you have a ROSC and the patient re-arrests and is now in a shockable rhythm do you shock at the next highest setting or do you revert back to 200 joules?For example, if one shock delivered on scene for an adult at 200J, then ROSC, then rearrest - next shock (as I suggest) would be 300J.

Question: Under the Adult Analgesia Medical Directive, it indicates that for Mild-Moderate Pain, Acetaminophen and Ibuprofen should be considered. If the pain is mild-severe pain than ketorolac should be considered. If a patient is reporting severe pain as a result of isolated hip or extremity trauma, and the MOI is consistent with severe pain, does this mean that only ketorolac should be considered, regardless of the patient’s ability to tolerate oral medications?
The way that I read this is that Acetaminophen and Ibuprofen would not be indicated if the pain is severe.

Question: At our recent recertification, I posed a question that was answered by a doctor. This was regarding the ability to call a cardiologist if we had a patient with a STEMI who did not have chest pain. Her answer was: “not at this time”. However, in conversation with medics from other classes, this seems to contradict what they have been told. Can you please clarify?
br>Also, are we to continue to understand that once a patient is out of the STEMI protocol (e.g. with vitals) that they continue to be so even if the vitals improve to within proper range?

Question: Upon review of the new Field Trauma Triage Guidelines, colleagues and I noticed that those patients who have sustained penetrating trauma to the head/neck or torso (with or without vital signs) should be transported to the lead trauma hospital providing it's within 30 minutes transport. Our question is why is this not the case for blunt trauma patients (in particular, those patients VSA from blunt trauma)?

Question: An ACP is doing an inter-facility transfer of a 16 year old patient with a fracture. During the journey the patient's pain becomes severe in nature. The sending facility had been administering 1mg doses of Morphine with good effect however the medical directives would indicate that the paramedic should administer a 3mg dose of Morphine.

Can the paramedic elect to give a lower (1mg) dose since it has been already proven to be "the right dose" for this patient, or does this require consultation with a BHP

Question: We have been trained on the Opioid Toxicity Medical Directive and the educators reiterated to use it as a last resort because of the potential for violence. I understand their concerns. I also appreciate these kits are out in the public for use and our skill set should continue to exceed that of the layperson(s). However, I wonder why not consider expanding the king LT insertion medical directive to include GCS = 3 for PCPs? This would allow safe and effective airway management of suspected overdose patients (or other GCS = 3 patients), even in situations of long transport times. We already preform this task in situations where a ROSC is obtained. We are familiar and proficient with the equipment and there is no additional cost to the services.

Question: Just to clarify about Ketorolac. The indications states “localized hip OR extremity trauma”. Are we to interpret this as isolated (single) hip AND isolated (single) extremity trauma? For example, if an old lady has fallen and broken both wrists, can we administer Toradol?

Question: I had a question about the ACP Pain Management Medical Directive. I can give 4 doses of 5mg max of morphine (a total of 20mg).  If I give a loading dose of let's say 4mg to achieve the desired effect then I could give maintenance doses of 2mg every 5 min to keep the patient's pain controlled. So instead of giving 20mg over 15 min I could give it over 40 min. This way I am giving a smaller dose, hopefully meaning I have less side effects (nausea, vasodilation) and if I have a longer transport time can better manage my patient's pain for longer. I understand that Base Hospitals are very strict about giving only 4 doses. Thank you. PS: I think this is a great tool!