Date Archives: 22-Aug-2012

Question: I'm curious if it is recommended to take blood sugar readings on VSA patients? If a blood sugar is taken on a VSA patient, and the reading is < 4mmol/L (which may be quite common due to the sample being capillary and CPR not perfusing sugar to the extremities), do we treat with Glucagon or D50? What if we suspect the patient is VSA due to a diabetic event? Does the answer change whether I'm a PCP or an ACP? Thanks!

Question: Example: A patient presents generally unwell, lightheaded and feels like their heart is beating fast, not an unusual call for any paramedic. On exam the patient has a pulse of 130-150 BPM, sinus tach to match on the monitor and BP is 100-110 systolic. Would it not be safe to assume that the BP is being maintained by the HR?

The question: Could this patient not benefit from a one time fluid bolus/challenge of 250ml to see if it decreases the HR decreasing cardiac demand and maintain the BP thus being beneficial for the patients overall condition? I realize that the IV and fluid therapy directive is for a BP less that 90 Systolic and is to ensure that a patient has an adequate perfusion or actual/potential need for medication, however would this not fall under the fluid therapy part of the IV and fluid therapy directive?

Question: Can an off duty medic who stops to assist an on duty crew the care (in the area for which he works and is certified) at an accident scene or medical event provide advanced care i.e. IV, med administration injections etc.?

Question: I have recently heard several answers to the following question, so I would really appreciate hearing the answer. How many IV attempts are allowed/permitted/encouraged per paramedic/patient?

Question: I'm an ACP in my primary service, but I am working as a PCP in a different service. Does my IV certification status automatically transfer directly to the service in which I am working as a PCP? If so, I have not been trained on the equipment being used in my PCP service and would prefer not to use my IV skills there. Am I obliged to?

Question: I have recently received an ACR audit, and have spoken to others, within my service, who have received audits as well, stating that a DNR patient who has not arrested should be ventilated via BVM. Everyone is under the impression that a DNR patient should not be bagged. I know that I have had previous conversations with SWORBHP educators in which the final word on this subject had been no BVM in the presence of a DNR irregardless of whether then patient was VSA or pre-arrest. A similar question on this issue was previously asked and answered on 1-March-2012 with the resulting answer being "therefore, to answer your question, if a valid DNR form is available, none of these "advanced cardiopulmonary resuscitation" procedures should be initiated, period. The SWORBHP medical directors would suggest that this is independent of whether or not the patient has completely arrested or not". The question now is what is the right thing to do? What we have previously been told is right or what the auditors are now saying we should be doing? Could you please shed some light on the situation because there's once again a lot of confusion surrounding the correct application of the DNR. Thanks.