Date Archives: 8-Apr-2014

Question: Penetrating without neurological deficits. Delay on scene to spinal immobilize?

Question: On a recent ischemic chest pain call with an approximately 60 year old female patient, conscious and alert, 2 nitro sprays prior to arrival. The 12 lead was normal and I gave ASA, but decided to withhold nitro as I had difficulty obtaining a BP on scene. The patient had no palpable radial or brachial pulses bilaterally. My partner and I made 4 NiBP attempts on scene with no reading on either arm and manual BP attempts bilat with no sound on auscultation or deflection of the needle. I was unable to also confirm the HR that showed on the monitor as she was uncooperative while attempting a carotid (although present). After extricating the patient on a stair chair, I decided to continue my care with an IV TKVO in the truck. I did not want to delay scene time any further. While in the truck I continued to attempt NiBPs which was now displaying a reading of hypertension, yet no pulses other than carotid were palpable. Although the monitor was always showing vitals within my parameters to administer nitro, I withheld it, as I was treating the findings with the patient, not the monitor. She had stated her pulses were usually weak. She remained conscious and alert with no signs of hypotension other than weak/absent pulses. My question is… was I ever justified to administer a bolus to this patient?

Question: In the thermal burns webinar very near the end, mention was made of London Fire carrying an ointment for treating burns. If Fire had not applied this prior to a paramedic taking over care for the patient, could the medic allow the ointment to be applied or apply it themselves? Or would this fall out of our scope of practice because such treatment isn't mentioned in the BLS or Medical Directives?

Question: With the Middlesex-London Health Unit distributing Narcan to the public for high risk users, I can't help but picture getting sent code 4 for an overdose and on arrival a bystander hands us this kit because they didn't want to be the Good Samaritan drug user. Will there be any changes to the Narcan Medical Directives to somehow include PCP's in the near future?

Thanks in advance.

Question: Here is a question that has been up for debate from a few paramedics I work with. If you have a penetrating trauma, either in the chest or back, the BLS states to immobilize the object and transport to the best of your ability.

If the patient were to go VSA and the object was impeding CPR, either from the chest or back (not being able to do proper compressions), it was my understanding that we as paramedics are supposed to remove the object if we cannot do proper CPR instead of working around the object, which is the counter argument. What is the direction regarding this?

Question: You respond to a call for a 57 year old male patient who collapsed while cutting the lawn. On arrival, his neighbour who witnessed the arrest, reports that she saw him fall and when she checked on him, she realized that he was in cardiac arrest and started CPR. You confirm that the patient is VSA and quickly apply the defib pads. You deliver one shock and start CPR again but the patient begins to moan and tries to raise his arms. Your next action would be to...?

Question: I have overheard a couple of crews recently discussing the ACP cardiac arrest protocol for when you arrive on-scene and a PCP has already initiated their protocol.

I've overheard that some crews use what the PCP crew has done (say two no shocks) and then just do two more and either call for pronouncement or transport. I also know other crews that will show up and do their entire three rounds of epi, etc. and then call/leave regardless of how many or what the first arriving PCP crew has done.

I know what I do but which one is actually correct because now I'm wondering if I'm doing the right method.

Question: I am seeking direction in the management of a patient(s) who have sustained exposure to Hydrogen Sulfide (H2S) in suicide; taking into account the presenting HAZ-Mat situation and the associated dangers to 911 allied agency personnel. Specifically, assessments, resuscitation, TOR, field pronouncement, transport guidelines and recommendations.

My major concern is the potential harm to transporting crews due to external ventilation of the lethal gases notably if the Fire Dep't "4 Gas Monitor" monitors indicate a presence of H2S.

Question: In the case of a post-ictal combative patient, is time considered a "reversible" cause? I'm hesitant to jump to sedation for somebody who could resolve on their own in a few minutes. However, today we had a case where we held off, but the patient was not improving and beginning to pose a danger to himself so we went ahead with the standing order. Should we have initiated it immediately? Or if safe for the patient wait to see if they do resolve on their own, and what would be an acceptable time frame?