Date Archives: 20-Dec-2013

Question: A nitro virgin patient presenting with chest pain attends a doctor's office. Doctor administers 1 spray of nitro prior to EMS arrival. Upon assessment by EMS, patient still presents with chest pain. Is the patient still considered a virgin nitro patient as this is the first incident he/she has had with nitro? Or since the doctor administered a spray, does that count as a previous use of nitro?

Question: If you come to a scenario being a PCP paramedic uncertified in IV, where when finding and assessing the patient you come to terms that he/she is VSA due to anaphylaxis.

Do you have to administer epi, because in the protocol for administering epi on a VSA, it says "in the event anaphylaxis is suspected as the causative event of the cardiac arrest, a single dose of 0.01mg/kg 1:1000 solution, to a maximum of 0.5mg IM, may be give prior to obtaining the IV/IO". Since it is saying you "may" give it, do you know if you have a choice?

Question: Multi-part question on croup. I've heard that croup is becoming more prevalent in older children (8 years & up). What is the incidence of croup in older children, and how would their treatment differ in the ER from the < 8 year old group?

Question: I recently did a transfer with a physician going to LHSC University Hospital with a confirmed subarachnoid bleed. The patient was conscious, conversed and was oriented x 3. They were mildly lethargic, c/o an occipital headache with no neuro deficits. The physician accompanied the patient to give a medication to keep the BP on or around 140 systolic.

During transport, the patients BP began to rise to 160-180 because of nausea and vomiting. Gravol was administered and a drug (sorry, I can't recall the name).

He asked me if we carried anything that could drop the BP. He suggested Nitro. I know this is not listed as a contraindication but would it be wise to give a vaso dilator to a patient with a cerebral bleed. We did not administer nitro, but the question still remains. Thanks in advance.

Question: We are instructed to get the nitro in, if applicable, apply the CPAP and if there is improvement, do not remove the mask for additional nitro sprays. Is the improvement slight or significant? If slight improvement, do we leave the pressure at the slight improvement pressure or titrate 2.5cmH2O?

Question: If respirations are at or above 28, historically paramedics are taught to assist via BVM. What is the rationale with pulmonary edema to apply NRB with tachypnea instead of assisting with a BVM until CPAP and or nitro is prepared?

Question: There is some debate in regards to chest compression's, monitor applied, analyze and then airway. What happens when the compression count is at thirty and the pads are still not applied? Does the paramedic at the chest check the oral cavity, get the airway, insert it, open the BVM bag, prepare the BVM and attempt 2 breaths or continue compression's until the other medic applies the pads and the analysis is complete?

Question: I was told by a physician that a DNR becomes void with a suicide attempt. I was wondering how we should approach this situation.

Question: I was taught that if there is some clinical improvement, when using CPAP, we are not to titrate the pressure any higher. I understand the rationale for this, however my question is, are there clinical guidelines that quantify a patient having sufficient "clinical improvement"?

Example being a patient breathing at a rate of 34 bpm with accessory muscle use, sp02 of 85%, audible crackles through all 4 lobes. With CPAP applied at 5 cmH20 vitals improve to RR of 28 bpm, sp02 of 91% and crackles remain. This patient has had a degree of improvement but would it not be advisable to titrate the pressure 2.5 cmH20 higher (after 5 mins) to attempt to further normalize the patient's VS and clinical condition? Or is the goal to increase the sp02 above 90 % with no accessory muscle use and decrease RR below 28 bpm as the directive lists these as conditions needed for application.