Date Archives: 27-Apr-2021

On our ACRS, when we have rhythm interpretation and if we are unsure of what the rhythm is, is it okay to leave it blank?

Why is nasotracheal intubation reserved for patients above the age of 8?

Do we still suction neonates immediately after birth?

If our patient has been accepted for Bypass under STEMI protocol, and pt goes VSA on route, in the event of a ROSC do we continue to proceed to Cath lab or do we now reroute towards closest ED?

Tension pneumothorax Could someone please clarify the BLS section on ventilating a suspected tension pneumothorax. Is it just slower and not as hard of a squeeze as usual

In regards to the LAMS score, is it to be used for acute changes only if a patient has deficits from a previous stroke? For example, if the patient already has a weak grip and arm drift from a previous stroke with no reports of acute changes, however they have facial droop that is reported to be new then is only the one point for facial droop counted?

Question in regards to the IM epi in 'less than 50 year old patients with Severe Respiratory distress, bronchoconstriction, and a history of asthma without other contributing cardiorespiratory comorbidities' Does this mean if the patients is less than 50 year old with Severe SOB and signs of bronchoconstriction and a history of asthma but also has a history of COPD or CHF, then we do not consider IM EPI?

Question: with regards to the Trauma Cardiac Arrest Medical Directive, do you support the placement of a pelvic binder on the patient assuming severe blunt trauma? I understand that under the Blunt/Penetrating Injury Standard in the BLS it is stated: "if the patient has a pelvic fracture, attempt to stabilize the clinically unstable pelvis with a circumferential sheet wrap or a commercial device". Furthering this thought, the Intravenous and Fluid Therapy Medical Directive found within the ALS PCS now states: "An intravenous fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes." Thinking about this all together has me wondering that if a patient who is VSA secondary to severe trauma is eligible to receive an IV bolus to presumably treat hypovolemic shock, would the use of a pelvic binder be supported in the same way? If so, when would be the recommendation to apply a pelvic binder when treating under the Trauma Cardiac Arrest Medical Directive? Thank you.

Can you give gravol to a normally altered (Alzheimer’s) patient?

Hi Doc(s), Two unrelated questions I've been pondering over the last couple of days: 1. In the field I've noticed some paramedics withhold dimenhydrinate administration if the patient has already taken any Gravol in the last 4-6 hours. However, the medical directive does not specify a time and simply states overdose on antihistamines or anticholinergics or tricyclic antidepressants. My understanding of their logic is that additional Gravol may cause an overdose in the patient however Gravol brand themselves recommend a dose of 1-2 50mg capsules every 4hrs PRN... Could you please provide some further clarification on this practice, and if we should still be administering it if we do not suspect an overdose but that the medication has been taken appropriately. (and similar practice for if the patient is taking tricyclics or anticholinergics as prescribed to them) 2. I recently had a COPD exacerbation patient who I believe would have benefitted greatly from CPAP. He had equal lung sounds through all fields with no paroxysmal chest movement, however there was a recent history of a collapsed lung approx. 6 weeks prior. (Unknown cause, from his history I suspect possibly a bleb/bullae) The current extenuating circumstance of COVID-19 aside, should CPAP be considered in this patient? Although I am not suspecting a current pneumothorax, due to the recent history I would think that weakening of the lung tissues could put the patient at greater risk for a recurrent event if subjected to significant positive pressures. Thank you and stay safe!

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