RPPEO MedicASK

Welcome to MedicASK. This section of the RPPEO website provides paramedics the opportunity to ask questions to our Medical Directors regarding ALS PCS medical directives or other related patient care opportunities.

All questions will be reviewed and answered by staff within the RPPEO. Please browse through our questions and answers, as well as the latest ALS or BLS Patient Care Standards or Companion Document for the Advanced Life Support Patient Care Standards.

Medical Directives

MedicASK questions that have been answered by the RPPEO are posted below.

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Opioid Administration and Severe Pain

Question: For the Analgesia medical directive. For Morphine and Fentanyl, patient need to be in severe pain. The only place I can find the definition of severe pain is in the cardiac ischemia prot...

Sedation and Analgesia Post TCP - BHP consult or not?

Answer: When consulting with a Base Hospital Physician for Transcutaneous Pacing (TCP) authorization, we recommend a proactive approach and anticipating the need for sedation and analgesia. We r...

Nitro or No Nitro when Pain Free

Answer: The answer to your question will depend on the clinical presentation of your patient. When you are suspecting your patient is presenting with cardiac ischemia, it is appropriate to cons...

Defibrillation in a moving vehicle

Answer: We recommend that once transport has been initiated, the focus should be on rapid transport and quality CPR. There is a de-emphasis on continued defibrillation, as multiple studies have ...

60 minutes from 1st pt contact definition

Answer: The STEMI bypass specifies that transport to a PCI centre ≥60 minutes from patient contact is contraindicated. First patient contact within our region is defined as first patient contac...

Choosing IM Needle Length

Answer: Selecting the proper needle length for IM injections will vary depending on factors such as age, gender, weight and anatomical location. Given the glucagon needle is 5/8 in in length, it...

CPAP with Pneumonia and COPD

Answer: CPAP should be considered when the paramedic suspects a working diagnosis of Pulmonary Edema or COPD exacerbation. These are often identified by adventitious lung sounds (ie crackles and...

Pediatric Bradycardia with a Pulse

Answer: As management of pediatric bradycardia with a pulse is not currently in the ALS PCS, we recommend to consult with a Base Hospital Physician to discuss a management plan using the AHA Gui...

Cardiac Ischemia, morphine and 7/10 pain threshold

Question #: 401 Question: Why is the pain management protocol for cardiac ischemia written in a way to limit pain medication use until the patient reports a 7/10 or greater, especially given that...

CPAP - Medical Directive vs Sleep Apnea

Question #: 406 Question: What is the difference between home CPAP for sleep apnea and CPAP we carry/our medical directive? Why can people with sleep apnea can use CPAP while sleeping (not sittin...

Dopamine discontinuation - from ROSC to VSA

Question #: 381 Question: In the event of a rosc and I'm running a dopamine infusion where my patient re arrests, should I still discontinue dopamine over 5-10 minutes at this time or immediately...

COVID 19 considerations - EPI interval - bronchoconstriction

Question #: 389 Question: For the COVID considerations it says to consider IM epinephrine as per the bronchoconstriction medical directive to a maximum of 2 doses. What would the dosing interval ...

Gravol admin if patient self-admin and still nauseated

Question #: 371 Question: Can a Paramedic administer Gravol to a patient even if there is previous self-administration, but the symptoms are still present? Is it considered an overdose? Answe...

Opioids, analgesia and pregnancy

Question #: 366 Question: Should we withhold narcotics to treat a pregnant patient for pain management? Answer: The Analgesia Medical Directive allows you to use opioids to manage severe pai...

Adenosine administration when BP 90-100

Question #: 370 Question: Tachydysrhythmia- conversation with ACP's regarding Adnenosine. Case in point, ACP treated patient with 6mg IVP, no change in rhythm but the BP dropped to 96 systolic. T...

when to put a cardiac monitor

Question #: 364 Question: Is it an RPPEO expectation that we must always attach a cardiac monitor before administering any medication? Answer: The ALS PCS is no longer specifying that a...

Nitro admin and Inferior Wall MI

Question #: 361 Question: Just recently did an inferior MI pt with ST elevation in II, III and avf with reciprocal changes to V3 to V6. We did a 15 lead by putting v4 on the right side and it was...

Pulmonary Edema, Cardiac Ischemia and Nitro

Question #: 360 Question: When it is determined the patient is experiencing cardiac ischemia and also presenting with acute pulmonary edema (IV established, BP over 140) should the treatment plan...

Verbal DNR and BHP patch

Question #: 359 Question: VSA patient with a verbal DNR from spouse. In a PCP/ACP split crew situation would the expectation be for the ACP to do the patch to the BHP to authorize the honouring o...

Stoping to analyse

Question #: 357 Question: In the event of a medical arrest (pcp semi automatic - no manual mode) , if it is decided that it fits a special circumstance and transport is initiated after the fir...

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