2022-01-19 | SWORBHP Ask MAC

Date Archives: 2022-01-19

January 19, 2022 SWORBHP Category: Cardiac Ischemia, STEMI Bypass | Date: 2022-01-19

Would the presence of De Winter T waves be enough to transport the patient to the cath lab. I know its considered a STEMI equivalent but there is no actual ST elevation.

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January 19, 2022 SWORBHP Category: Medical Cardiac Arrest | Date: 2022-01-19

The AHA and COVID-19 guideline has a caveat that states in "suspected or confirmed COVID-19 cases" we should implement the prescribed practices. In the event that the patient in cardiac arrest is not confirmed or suspected to have COVID-19 symptoms is it reasonable to every to pre-pandemic practice of resuscitation?

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Medical Cardiac Arrest

January 19, 2022 SWORBHP Category: Cardiac Ischemia | Date: 2022-01-19

Does a prescription of NTG patch count as previous history of use for NTG spray? Would it be a concern that the medication would be administered through a different route and therefore have a different onset of effect?

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Cardiac Ischemia

January 19, 2022 SWORBHP Category: Nausea / Vomiting | Date: 2022-01-19

Antiemetics: unrelated to our current directives but I was just wondering what the rationale was for specifically using dimenhydrinate as our prehospital antiemetic option? As I understand it, and I've had a number of conversations with physicians of different disciplines regarding the same, dimenhydrinate is most effective for motion sickness, and other antiemetics exist that are typically more effective for the types of emesis that we typically deal with in the field.

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Nausea / Vomiting

January 19, 2022 SWORBHP Category: Cardiac Ischemia, STEMI Bypass | Date: 2022-01-19

Why do you only give 3 sprays of nitroglycerin to a STEMI positive patient?

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January 19, 2022 SWORBHP Category: Bronchoconstriction, Medical Cardiac Arrest, Moderate to Severe Allergic Reaction | Date: 2022-01-19

When dealing with an anaphylactic patient, the PCP medical directive says to administer up to 2 doses of epi at a maximum single dose of 0.5mg, whereas the bronchoconstriction AND cardiac arrest medical directives are only one dose at a maximum single dose of 0.5mg. Can some explain why?

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January 19, 2022 SWORBHP Category: Intravenous and Fluid Therapy | Date: 2022-01-19

I have had a few calls to nursing homes where the patient’s IV fell out and the patient is being sent to the hospital for an IV restart. If the patient does not have any complaints otherwise, would an IV certified crew be able to start the IV and patch to not have the patient transported? If so, would this be documented as a refusal? I have always transported these patients but it would be helpful to know if there are other options to avoid an unnecessary trip to the hospital. Thank you!

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Answer:
When it comes to IV initiation in the 9-1-1 system, there are risks with completing this procedure and then leaving the patient at home. Why is the IV in place: Has the condition worsened? Who is going to follow up with the patient and monitor the IV site and infusion? Furthermore, the Intravenous and Fluid Medical Directive was not developed for the purposes of “treat and release”, but rather for medical treatment (or potential need for medical treatment) for 9-1-1 patients that require emergent care. The safest thing to do in these scenarios when a 9-1-1 call is initiated for an IV start is to transport the patient to hospital.

The 9-1-1 system is designed so that when a patient calls they are conveyed to hospital unless they have capacity to refuse transport. The Ministry is now working on new Patient Care Models whereby not all patients that call 9-1-1 are transported to hospital and as such models of treat and release, treat and refer, or treat and transport to alternate destinations, are being developed, piloted and reviewed. Of note, the Ministry is working with the Ontario Base Hospital Group and reviewing patient populations as part of the Phase 2 roll out of alternate Patient Care Models within the 9-1-1 system. This may be one patient population that the Ministry is interested in studying for these Patient Care Model Standards.

Unfortunately, the use of 9-1-1 paramedics to initiate IVs (ex. on behalf of home care nurses or Long Term Care facilities) may have some unintended consequences whereby resources from the 9-1-1 system are being utilized inappropriately and 9-1-1 paramedics become the traveling IV team. However, for now, SWORBHP Medical Council would not recommend the routine practice of patching to the BHP to start an IV and leave the patient behind, for the reasons stated above.

There are agreements between some services and physicians/care practitioners to provide paramedic care to patients outside of the 9-1-1 system, via Community Paramedicine. In this model, the paramedics can utilize skills as directed by a medical director separate from SWORBHP. This care team closely follows up on patients, providing ongoing care. This may be one avenue that some Services have to deal with these types of community calls that should not be within the realm of 9-1-1 care.

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Intravenous and Fluid Therapy

January 19, 2022 SWORBHP Category: Orotracheal Intubation, Supraglottic Airway, Pediatrics | Date: 2022-01-19

The updated AHA guidelines indicate an increase in the ventilation rate to 20-30 breaths per minute for children and infants respective in INTUBATED patients. Does this apply to patients who have a supraglottic airway in situ as well? Thank you!

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January 19, 2022 SWORBHP Category: Medical Cardiac Arrest | Date: 2022-01-19

Follow-up question that was asked on 29-Jan-2021 about pulse checks after no shock is indicated. Base hospital answered that pulse checks should occur concurrently with each rhythm analysis. Is this true for those of us that are using S-AEDs rather than manual rhythm analysis? The reason I ask is because First Aid & CPR courses suggest that touching a patient during an AED analysis will introduce artifact that could affect the accuracy of the analysis.

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Medical Cardiac Arrest