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

What is your question?

Name(*)

Only letters and the following characters are accepted: -, é,è,ê,â,à,á,ü,ç,'

Email Address(*)

Invalid Input

Please let us know your current status as a Paramedic.

Invalid Input

Question(*)

0/1000

Invalid Input

Answered

Invalid Input

In this section

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

If you are unable to find your specific topic please complete the new question form.

MedicASK Categories

MedicASK Search

Most Recent Questions

Ketorolac - Accepted Routes

Question#: 553 Question: The Ketorolac vial labels state "IM" route only. Is it acceptable to utilize this preparation intravenously (diluted of course) Answer: Intravenous ketorolac is su...

Teleflex MAD 300 and Dead space

Question#: 555 Question: Our nasal atomizers are the Teleflex MAD 300. The specs for this are that the dead space is 0.06 ml. Dead space is not mentioned in the standing order? Should we add...

STEMI after ROSC

Question#: 546 Question: In regards to STEMI bypass, if you have a patient who is initially VSA and then obtain a ROSC, then discover a STEMI upon 12 lead interpretation.... do you proceed t...

Inadvertent Arterial Cannulation

Question#: 549 Question: In the event of known/suspected arterial cannulation while attempting intravenous cannulation, what course of action is most appropriately prehospital? Especially in...

Pulse Check in Hypothermic Cardiac Arrest

Question#: 551 Question: Greetings! I have seen in the Companion that the recommended pulse check for hypothermic patients is 10 seconds, as per AHA guidelines. The only reference I found ab...

CPAP & Nebulized Medical Administration (COVID)

Question#: 545 Question: Hi Dr. Dionne, Thank you for all the work that you do and your never ending support for us. I have a question with regards to CPAP and nebulized medication administr...

Supraglottic Airway

Question#: 544 Question: In the setting of a cardiac arrest, a supraglottic airway (SGA) is inserted for ventilatory assistance and/or airway control. Within the ALSPCS Companion document ...

Pericarditis: Prehospital Treatment Options

Question#: 540 Question: During my preceptorship, we carried an 18y/o female Pt who had received the 1st dose of her Covid vaccine on Thursday. Today was Saturday. The Pt was diagnosed with ...

Treatment Prior to Arrival - Care and Documentation

Question#: 534 Question: There are a few, private first aid companies operating in the province. Occasionally we are dispatched to events that they are providing coverage at. Some are admini...

Palliative Care Medical Directive use for non-registered/non-palliative patients

Question#: 542 Question: With the new PCP & ACP Special Project Palliative Care medical guidelines, is it possible with a patch to BHP to use these new drugs to treat non-palliative pati...

COVID considerations - Aerosol Generating Medical Procedures (AGMPs)

Question#: 535 Question: With regards to COVID 19. Most Paramedics have received both dosages of the vaccine. Case numbers are decreasing. When are we going to be allowed to administer nebul...

ALS PCS booklet availability

Question#: 539 Question: Hi there, I was wondering if RRPEO is still making copies of the ALS/PCS for distribution. I have a few staff requesting a hard copy as they prefer it to the app, e...

Analgesia and Abdo Pain

Question#: 528 Question: With regards to Adult Analgesia. Does the standing order allow for Advanced Care Paramedics to treat generalized abdominal pain, with Morphine, Fentanyl or Ketorlac?...

Nitro and AFib

Question#: 490 Question: Is it appropriate to treat a patient in a fast uncontrolled a-fib who is experiencing cardiac ischemia type pain under the cardiac ischemia protocol? OR is it more a...

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...

Pharmacology Resources

Question #: 485 Question: I'm currently studying for the ACP entry exam and I'm struggling to find consistent statistics on drug onset/peak/duration times. I started with the Ontario Base Hos...

Symptomatic Brad in Neonates: cardiac arrest or symptomatic brad?

Question #: 489 Question: We would like clarification about the correct destination for a neonate less than 24 hours old. Patient is intubated, CPR in progress because pulse less than 60 bpm,...

Increasing mA beyond initial electrical capture threshold

Question #: 480 Question: In the procedure of TCP, upon electrical capture do you add 10 milli amps even if you have mechanical capture with signs of perfusion Answer: During transcu...

Analgesia – opioids and headache contraindication

Question #: 479 Question: Why is headache a contradiction for morphine and fentanyl Answer: The headache contraindication for morphine and fentanyl administration is for isolated hea...

Rationale for hypoglycemia 3mmol/L contraindication

Question #: 478 Question: Why is an untreated BGL of 3.0 mmol/L a contraindication for the acute stroke bypass protocol when the ALS PCS definition of hypoglycemia for patients 2 years and ol...

Refusal of Service Documentation – patient walking away

Question #: 455 Question: How do we properly fill out a 72 for a patient who may or may not be cooperative with EMS, who walks away swearing/agitated, who refuses treatment/transport, refuses...

Lidocaine Max Dose

Question #: 482 Question: My service recently began using Lidocaine instead of Amnio. I was refreshing the medical directives for Lidocaine use and do not see a maximum does under the Medical...

EPI IM in elderlies and gravol vs Benadryl in anaphylaxis

Question #: 426 Question: Male pt stung by a bee x 1 hour ago, no known Hx of reaction with previous stings. Prior to our arrival the pt was c/o urticaria, edema to mouth, & N/V. Pt had t...

Acetaminophen once ability to tolerate oral medication changes

Question #: 463 Question: under the analgesia medical directive; for a patient experiencing severe pain (8+/10 pain) where they are initially unable to tolerate oral medication due to patient...

Nitro and SBP drop by 1/3

Question #: 412 Question: Nitro and SBP drop by 1/3 Protocol states NTG SL is contraindicated if SBP drops by 1/3 or more of INITIAL value after NTG administration. If my first BP reading ...

Nitro & Cardiac Ischemia; Cardiac Arrest & Reversible Causes

Question #: 429 Question: 1. If you are presented with a suspected cardiac ischemia call where the pt denies any chest pain but has nausea, SOB and the 12 lead is STEMI +. Do you give nitro a...

Trauma TOR and ROSC

Question #: 430 Question: 1. With a trauma VSA , ROSC is not a contraindication so does that mean you can TOR someone if they ROSC and rearrest during the call and meet all indications for a ...

Alcohol ingestion and Acetaminophen

Question #: 436 Question: For analgesia, is Acetaminophen contraindicated in a patient who has had alcohol? Assuming there are no other contraindications. Answer: The contraindicatio...

Nuchal cord – manual means not working

Question #: 431 Question: During a delivery, if the nuchal cord is around neonates neck and cannot be slipped over head by manual means what is the protocol if the cord is pulsating/not pulsa...

Morphine administration when initial BP drops by 1/3

Question #: 388 Question: For ischemic chest pain the directives are clear that"If a patient’s vital signs fall outside the medical directive’s parameters (i.e.: hypotension), the patient can...

Patient Safety Plan

Question #: 410 Question: Hi there, I've heard the term 'safety plan' or 'patient safety plan' used, but I can't find any resources on what that means. Bryan Answer: A Patient Saf...

FBAO management from unconscious to VSA

Question #: 358 Question: PCP paramedics arrive on scene to a unresponsive patient with a pulse but respiratory arrest due to obstruction. The goal will be Chest compressions for the purpose ...

Morphine in Cardiac Ischemia

Question #: 361 Question: Good afternoon, 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 ...

All all answers

Local: 613-737-7228 | Long Distance: 877-587-7736

Ottawa, 2475 Don Reid Drive, Ottawa, On, K1H 1E2
Kingston, 400-1471 John Counter Blvd, Kingston, ON, K7M 8S8

Facebook

Twitter

Education Calendar