Date Archives: April-17-2023

For acetaminophen and ibuprofen, suspected ischemic chest pain is listed as a contraindication. Is this listed mainly to indicate that ischemic chest pain should not be treated with the analgesia directive? Could analgesics be administered to treat a different area of pain that is occurring at the same time as the chest pain that appears to be unrelated? For example, I had a patient with chronic pain that she takes acetaminophen for, but she was experiencing acute chest pain suspected to be ischemic. Would it be correct to withhold acetaminophen in this case and not provide treatment for the chronic pain that she is experiencing at the same time as suspected cardiac ischemia?

Why is diabetic ketoacidosis different than hyperosmolar state?

Would SWORBHP be ok with ACP paramedics utilizing the 4-2-1 rule for fluid maintenance rates in paediatrics. Especially, with the high incidence of RSV in the community compounded with sick kids who aren't taking in as much fluids and may be fluid depleted. Their fast respiratory rates and poor feedings, fever etc increases the insensible fluid loss. I can appreciate the current model, for fluid boluses utilizing the 70 mmHg + (2 x age in years). However, at this point they are decompensating rapidly with the hypotension and progressing to pre-arrest (with signs of delayed peripheral and central cap refill, looks sick as per PAT etc). Is the current protocol 15 ml/hr for

I was just wondering if SWORBHP is still maintaining the same stance for pediatric medical cardiac arrest (as discussed in the May 2022 Tip of the Week and other posts) for the new medical cardiac arrest directive in ALS PCS version 5.0? Is paramedic judgement still recommended for rhythms not amendable by defibrillation or is it expected that we run the cardiac arrest on scene for the full 20 minutes? I understand the research is trending towards scene times longer than 10 minutes for pediatrics (in some studies) and that earlier epinephrine administration has been associated with ROSC but this also leaves PCP only rural services in a very difficult grey zone to be addressed. I am by no means advocating for a "scoop and run" mentality (the new wording in the directive rules that out quite nicely) but any further guidance or clarification is greatly appreciated!

Is ASA considered a blood thinner? I understand it’s an anti-platelet and not an anticoagulant but is it still considered a blood thinner?

If I gave a drug to a patient who holds a valid Ministry DNR that resulted in either apnea or respiratory depression, can I bag that patient since I essentially caused the respiratory problem?