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RPPEO MedicASK

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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.
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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.

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MedicASK Categorys

Benadryl & Gravol

Question #: 304

Question:


In an anaphylactic adult patient, who has symptoms of nausea/vomiting, can both 50 mg of Dimenhydrinate and 50 mg of Diphenhydramine be co-administered? Assuming no other contraindications present.

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Confirmation of Asystole

Submission ID: 303

Question:


Did a trauma VSA, where I called for a TOR. Pt fit the criteria: no palpable pulse, no shock delivered, and monitored HR=0. However my QA supervisor told me I should be putting on the limb leads, and cycle through leads to confirm HR is actually 0, and that it was not fine v-fib.

Is the defib pads not enough to confirm asystole? Does RPPEO want limb leads on trauma VSA? and are we do do that for medical VSA?

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Intraosseous sites

Submission ID: 298

Question:


Can we use the proximal humerus as an access site for an IO under the Adult Intraosseous Medical Directive without patching?



After research in the Companion Document, the current ALS PCS and the Intraosseous Site Guideline (under the Medical Reference Tab in the OPCG app), there doesn't seem to be any restriction on the location for an IO access in the RPPEO. Are ACPs allowed to do this without patching?

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Nitro vs SBP drop

Submission ID: 295

Question:


You have a patient who has a prior history of nitro use and BP greater than 140 and you administer Nitro 0.8 mg SL under the Acute Cardiogenic Pulmonary Edema protocol. What dose of nitro do you administer if the patients BP drops below 140 but remains above 100 and doesn't drop by 1/3? Are you to continue with 0.8 mg or drop to 0.4mg?

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Epinephrine in apneic patients

Submission ID: 294

Question:


As per the current bronchoconstriction directive clinical considerations, If a patient is apneic does this disregard the hx of asthma condition.

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Rounding Joules for Pediatrics

Submission ID: 292

Question:


What is the recommend rounding for joules settings on a pediatric VSA patient on the LP15? For example if I want to shock at 44J, do I pick 30J or 50J. Do we always round up, down or closest? Thank you.

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Cardiac Monitor Needed with Medication Administration

Submission ID: 293

Question:


I was under the impression the cardiac monitor needed to be on prior to any medication administration however, some colleagues say that this is false as it only needs to be on sometime during the call. What is the Base Hospital position on this?

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Amiodarone Interval Dosing

Submission ID: 287

Question:


When administering Amiodarone for a wide complex tachycardia it is infused over 10 minutes. Once finished you wait 10 minutes then administer the second dose?

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Contraindication to Gravol

Submission ID: 290

Question:


If a patient has a known allergy to diphenhydramine (Benadryl) is dimenhydrinate (Gravol) a contraindication to administer to my patient?

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Term Gestation

Submission ID: 251

Question:


For the ALS PCS Neonatal Resusciation Protocol, what is considered less than term gestation in weeks?

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Medical Directives App

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