Date Archives: August 5th 2021

Given that rapid atrial fibrillation and other tachydysrhythmias can result from myocardial ischemia; is it wise to provide ASA to these patients as a precaution. I am a PCP, and we don’t have a defined treatment for pulsed tachycardia.

In regards to an IV that you have established are other medical professionals allowed to use it to give drugs on way to hospital? Back story, picked up a female patient who had just given birth with significant post partum hemorrhage. Midwife onscene was unable to establish a line but you subsequently start one. Midwife wants to push oxytocin through the IV that you have established is this OK?

I had a patient who met the criteria for Nitro administration under the ACPE directive. The initial BP was 104/72, with no previous Nitro use, and unable to obtain IV access. The pt’s blood pressure in the back went up to 143/88 while in the back of the ambulance... can nitro be given now that the blood pressure has increased, even if the pt started <140 SBP?

I was just curious to see if there has ever been talk about the idea of reducing fractures in the field, rather then just femur fx's? Obviously following all of the same protocols as the sager. Not that I have done much research, but could the possibility that some sort of equipment be readily available? We have done so many of those calls that could have gone much smoother and at more of a comfort for the patient in the long run.

For the IV bolus directive when one of the contraindications is “fluid overload”, if a patient has CHF and is presenting hypotensive, and is not experiencing SOB but has chronic edema in his/her feet/legs is that technically a contraindication to not bolus? Considering that would fall under “fluid overload” ? What are the signs and symptoms of fluid overload you guys are wanting us to look out for and be aware of?

My question is regarding STEMI bypass and hyperacute T Waves. We were called out for a 60's male patient experiencing chest pain after some physical exercise. It was quite apparent patient was likely having a cardiac event upon arrival and first examination. Patient had 8/10 midsternal pain (pressure) with radiation into shoulders. Patient was clammy, cool and diaphoretic. Patient had a weak radial pulse. After giving ASA 12 leads were obtained. Each showing hyperacute T waves in the chest lead V2 - V5. No elevation is noted, upon multiple 12 leads. No nitro was given as heart rate was below 60, but a lock was established. Patient was stable and wouldn't have any of the contraindication to STEMI bypass. We are a rural service and closest hospital is 7 minutes away and transport time to the cath lab would be roughly 25 minutes. Just curious how base hospital would like us to proceed on these calls in the future? a - go directly to closest hospital as there is no elevation yet and doesn't quite meet STEMI bypass b- call the closest cath lab and let the cardiologist decide c- first call base hospital to ask for further direction to see if cath lab should be called, then proceed from there. Thanks in advance

Can you TOR someone who is in PEA

This has been a question of mine recently that not many people have the answer for in my service. My question is; if we have given the pt any sort of medication or initiated an IV can the pt be offloaded to the waiting room or to a bed in the hallway? Thank you in advance!

Would it be appropriate to contact a BHP requesting titrated sedation for a compliant and non-combative patient experiencing agitation with inability to remain still preventing proper assessment due to stimulant use? I find these patients are occasionally even difficult to transport due to writhing on the stretcher let alone perform an appropriate assessment.

Is it considered an Inferior STEMI if only II, aVF are presenting with ST elevation as they are technically not contiguous?