Date Archives: 4-Nov-2013

Question: We had our recert this week and I have a question about DNR patients. In the pocket book it says that a patient will get epi IM if they have a history of asthma and BVM ventilation is required. So I am wondering, if a DNR patient does not receive a BVM under any circumstance and an asthma patient with a valid DNR who started off just slightly SOB became severe and required a BVM would they still be eligible for epi? In other words does "required" mean that yes it is required due to the severity of SOB, but due to the fact they have a DNR they don't actually get the BVM, can they still receive the epi, which is not contraindicated on the DNR validity form? Thanks in advance.

Question: I was looking at the PCP Medical Cardiac Arrest Medical Directive. I understand that we can give IM epinephrine in the setting of an anaphylaxis induced VSA. In the event of a ROSC from this type of VSA can Benadryl be administered IM/IV? Is there any benefit to doing this?

Question: Is the IV protocol like others in that once the patient falls out of a protocol, they cannot be put back in. For example, patient initial BP less than 90 systolic, decision made to load patient prior to IV attempt, on loading patient BP now above 90.

Question: My question is about pain management. Our directive states a maximum of 4 doses of 25-50mcg fentanyl (200mcg max) or 2-5mg morphine. (20mg max). Is there a reason we could not just have a max total dose of 200mcg/20mg and be able to give, say, 8x25mcg fentanyl q5? I feel that with the increasing frequency of offload delays it could be beneficial to the patient for us to have the ability to spread the maximum dosage out over a longer duration.

Question: With reference to the cardiac ischemia protocol. Would it be possible to update the protocol for the administration of nitro (without a BHP consult) for normotensive patient on beta blockers by either: a) lowering the heart rate parameters from 60bpm to 50bpm or b) to lower heart rate parameter from 60bpm to 50bpm when patient is currently taking antihypertensive medications within the beta blocker family with an IV established?