Date Archives: 17-Jun-2013

Question: I am asked to transport a patient to the cath lab. The new onset unstable angina patient (who is bradicardic with a lowest rate of 38 and multiple unifocal pvcs) and is only CP free because of the nitro during patch put on by the ER doctor.

Does leaving the patch on constitute me giving a medication that is out of my skill set? Since she/he is bradicardic (but has a good pressure) do I have to remove it? Do I have the ability/obligation to remove a treatment started by the attending ER physician? Escort required? Other suggestions?

Question: I have been hearing a lot lately of BHPs telling PCP crews to give a drug (such as Epi) on a VSA when they call for a TOR. Even after reiterating that they were a PCP/BLS crew there still seemed to be some confusion. In some cases complicating the situation to the point where the misunderstanding seemed to lead to an order to transport as opposed to granting a TOR. Is there a better way to disseminate the differences to the doctors who may be taking the TOR or BHP patch (such as a card distributed to the doctors or a chart posted at the patch phones outlining what PCP crews can do vs. ACP crews)? I am sure it is as frustrating for the doctor taking the patch as it is for the crew trying to explain why they can't do what is being asked. Maybe something like this could help ease the whole process?

Question: You are called to a retirement home for an 85 y/o female for a possible CVA. On arrival you are met by a Nurse Practioner who stated patient is having a stroke. Nurse Practioner also states that patient (who is a retired RN) has talked to her family doctor who agrees with patient's decision of not wanting to go to stroke centre or stroke protocol done. Patient has history of heart. Assessment reveals patient alert, orientated x 3 and meets stroke protocol. Patient wants to be transported to the local hospital for assessment. Does this patient or any patient have the right to refuse transport to a stroke centre?

Question: With respect to use of an OPA, I have had discussions with coworkers who always will insert one with an unconscious patient. Is this proper? My argument is, even the MOH literature seems to state that 'less invasive' airway management such as positioning, suctioning and constant monitoring of the airway is acceptable. Some common situations of this would be a post-itcal or alcohol intoxication persons. Thanks.