Date Archives: 20-Jun-2016

Question: In regards to the CPAP medical directive, it states in the ALS PCS Companion document that CPAP is the treatment for Acute Pulmonary Edema (REGARDLESS of origin). Does this mean that the cause does not need to be cardiogenic in nature? Could you please elaborate on this?

Question: I have a question in regards to right sided MI's. We had a patient that had slight elevation in his 12 lead inferior leads, but not enough to call for a STEMI. I once worked for a service that I could do a right sided 12 lead ECG. Are we allowed to perform right sided 12 leads here at SWORBHP if we do suspect an inferior MI?

Question: In Ask MAC it states : "As for Ketorolac, daily ASA is not considered anticoagulation therapy as it affect platelet function and does not result in a true anticoagulated state." So PLAVIX (clopidogrel) is also affect platelet function, even though ASA affects the cyclooxygenase 1 (COX-1) pathway, and PLAVIX affect the adenosine diphosphate (ADP) pathway, still I think both PLAVIX and ASA affect platelet function . And I think daily dose of PLAVIX also not a true anti-coagulated state and Ketorolac is not contra-indicated. Please let me know if I am right or wrong by those explanations.

Question: If a person have a near fresh water (lake water) drowning and Spo2 <90 % severe SOB, and by auscultating lungs I hear Crackles all over the places mainly on lower lobes tachypnea and normotensive. As per CPAP protocol: indication severe respiratory distress and signs and/ or symptoms of Acute pulmonary edema or COPD is the indication, and patient is above 18years and no contraindication met, can I apply CPAP on this patient ? If not please tell me why and I know Nitro is not applicable in this case because this is not a cariogenic pulmonary edema.

Question: Recently we were on scene with an unresponsive 65 year old female. This was a witnessed event by a friend. While on route to the nearest ED patient’s condition improved. The patient started to answer questions. At this time the patient found to have left sided deficits. Should we continue to the local ED (5 min transport) or turn around for stroke bypass (50 min transport) After assessment in ED we ended up transporting to Stroke Unit.

Question: After the recent introduction of Narcan for PCPs, I'm still a little confused about the role of Narcan in an arrest. The 2010 AHA Guidelines state there is no role for Naloxone in cardiac arrest but the 2015 Guidelines are less prohibitive, leaving some room for interpretation. I understand that where there is question whether the patient is pulseless or not, there is a role for naloxone in the setting of presumed opioid overdose but what is the direction of base hospital for the use of naloxone where there is definite absence of vital signs in the setting of a PCP-only arrest. Is it the expectation of the base hospital that PCPs attempt to administer naloxone at some point during that call? If so, when during the cardiac arrest protocol? On scene or en route to hospital?

Question: Referring to the STEMI by-pass medical directive, is it 60 minutes from patient contact or 60 minutes transport time?

Question: Are we allowed to accept photocopied DNR? I have heard several discrepancies on this question.

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