Date Archives: 4-Sep-2012

Question: In the case of a patient who is in obvious respiratory distress with wheezes audible once you make patient contact (i.e. without auscultation), is it necessary to administer o2 via NRB first? Obviously these patients are in need of salbuMtamol and can not tolerate an MDI and spacer. The time it takes to first put on a NRB and then set up a nebulized treatment seems counter productive. Can we start with a nebulized treatment and then apply o2 via NRB after the 1st treatment while we reassess the patient?

Question: A patient requires assisted ventilations via BVM for shortness of breath for CHF or for exacerbated asthma, can we assisted ventilations for this patient. I understand that we cannot perform artificial respirations for a patient who is apneic, but can we assist ventilations with a patient who is conscious and breathing on their own, but needs assistance? Patient has a valid DNR.

Question: Just some clarification in regards to DNR's. If a patient is having an episode of an exacerbated Asthma and has a valid DNR, do we administer Epi for the asthma? I understand that we cannot "bag" the Patient due to the DNR status.

Question: In regards to a traumatic VSA. The patient goes VSA during transport to the closest ER. The paramedic believes the arrest is of trauma origin. Do we pull over and perform one analysis and then resume transport? Or do we just do CPR until we arrive at the ER?

Question: With these new medical directives, I was under the impression that we as medics are able to use our judgment and discretion on calls. It is mine and many of my colleagues opinion that oxygen is not required on all calls, maybe even some calls when you provide sympatientom relief, depending on the circumstances. Does MAC agree? Or should oxygen be applied to most patients, and in all cases that sympatientom relief is provided?

Question: To what extent am I allowed to take orders from a physician who is riding out with me? Are there any set guidelines to direct us and the physicians in this aspect? A recent resident riding with me said they had no issue with providing the order if it seemed reasonable. Narcan administration was used as an example as something that seemed reasonable. However the resident felt (and I agreed) something like a TOR order warranted a call to a BHP. Discussion of this subject would be appreciated.

Question: On medical VSA's, as an IV certified PCP, if you have time and enough hands to start an IV, are you giving a fluid bolus? I realize when you get a ROSC you are doing a fluid bolus of 10ml/kg (if chest is clear), but while the patient is VSA, are you giving a bolus? Or are you starting a line, just running TKVO in preparation of getting a ROSC and then bolusing?

Question: As a PCP, can you do an inter-facility transfer with a patient with IV running lactated ringers without an escort?

Question: I work out of a first response vehicle. If I start an IV to deliver a med such as gravol, and the patient will not require anymore treatment via IV and I am handing the patient over to a crew that is not IV certified what is my responsibility? Do I have to accompany the patient? Or can I lock the IV or can they monitor the IV TKVO?

Question: I just have a quick question regarding IV Monitoring. Are PCP's allowed to transport a patient without an escort who has an IV running lactated ringers? This question came up the other day at work and everyone seems to have a different answer. I just wanted to clear this up with you so I know the correct answer!

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