Date Archives: 7-Jul-2017

Question: In a setting where you arrive on scene and you are presented with a patient who is unconscious and is hypotensive, the patient has a valid DNR. Can you still administer fluids to this patient or does that fall under the same category as inserting an OPA/NPA and BVM to a patient with a DNR?

Question: This question may be a very rare situation but I have not been able to get an answer from any paramedics I have asked. As per the "Patching" section in the introduction of the ALS PCS the literature states "BHP cannot be reached despite reasonable attempts by the paramedic to establish contact, a paramedic may initiate the required treatment without the requisite online authorization if the patient is in severe distress and, in the paramedic’s opinion, the medical directive would otherwise apply". In a situation where a cardioversion is required and the unstable patient is still conscious, it is fairly common practice to ask for sedation and pain control (i.e. Morphine/Midazolam) along with orders for cardioversion. If multiple BH patches cannot be completed and in the paramedics opinion cardioversion is required for the unstable but conscious patient, are we able to administer sedation and pain control? I ask this because there is not a directive that directly deals with pain and sedation prior to delivering the cardioversion, but is common to ask for such direction.

Question: For teaching purposes. While assessing a patient, how important is it to determine any and all treatments or interventions provided to the patient by allied agencies, bystanders, self-administration or other medical professionals prior to the arrival of the Paramedics? How important is it to determine an accurate time line of those treatments or interventions? Is oxygen a treatment and/or intervention?

Question: Is PEEP being considered for inclusion into the paramedic scope of practice? I recently had a patient who was in CHF to the point of unconsciousness whom we would have absolutely given CPAP had he been conscious. Although PEEP isn't exactly the same as CPAP, would it not have potentially provided some benefit?

Question: I've heard of crews being asked to transfer patients between facilities with indwelling tubes and lines that are not within their scope, and they don't have suitable escorts. I had a colleague asked to transport a patient with a chest tube, without an RN escort, to which they refused, but recently saw a crew transporting a patient with a nasal epistax in-situ. I know these have the potential to migrate and cause airway obstruction so didn't think we should move these without a hospital escort. Could the Base Hospital provide some direction so that it is clearer to paramedics as to what they should do in these cases?

Question: In the event we have a patient who is STEMI positive, with symptoms of CHF (crackles/pitting edema) who is hypertensive >140 systolic BP are we to treat with 0.8mg of nitro for the CHF or 0.4 mg under the ischemic chest pain protocol? Also with the new STEMI standard dropping down to 3 - 0.4mg SL doses of nitro maximum, will that change out CHF protocol for nitro administration if both problems present together?

Question: CPR guidelines: I understand that we start CPR with a patient less than 16 years old, heart rate less than 60 and signs of poor perfusion, agonal respirations as per the CPR guidelines. My question is if we have the same situation with an adult patient, what would be beneficial for this type of patient (CPR)?