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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 Answers

Pediatric Field Trauma Triage Standards

Submission ID: 228


We recently did a 4 year old Trauma by-pass to Kingston General Hospital under step 3 of the bypass for fall greater then 3 meters.

We are now being told by our service that pediatrics DO NOT fit under the "60 minute transport time" window, only adults. We are unable to find any specific info/guidelines stating such.

My questions:

1. Do pediatrics fall into the 60 minute transport time?

2. Is CHEO the LTH hospital for pediatrics to the north east or are they transported to the civic?


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Ventolin during Cardiac Arrest

Submission ID: 226


In the context of a pediatric cardiac arrest where the causative event would be anaphylaxis and you are a PCP crew and there is presence of airway edema with bilateral-diffuse polymorphonic expiratory wheezes; can we still treat with MDI salbutamol and if so, how would you deliver Salbutamol appropriately with a compression/ventilation ratio of 15:2?

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CPAP and pneumonia

Submission ID: 223


Is it appropriate to use CPAP in severe respiratory distress, suspected to be pneumonia? Pt is conscious with crackles through out, low SPO2 and obvious distress.

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Ventolin nebulized

Submission ID: 218


In the case of an asthma exacerbation (severe enough but not to the point of administrating Epi) or in the case of an anaphylaxis, would it be appropriate NOT to wait the 5-15minutes in between treatments of Salbutamol? If not, what would be the rationale of waiting that 5-15minutes.

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Oxygen Administration for Cardiac Ischemia

Submission ID: 216


When dealing with a pt with chest pain (cardiac ischemia) that you are treating with nitro and ASA, is it appropriate to administer oxygen via nasal cannula at 4-6lpm or is high flow using NRB at 10-15lpm the only option?

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Cardiac Arrest - Hangings

Submission ID: 215


2 questions:

Is there criteria's to help determine if a hanging is medical versus trauma (example patient fell two times the patient's height...)

I treated a trauma hanging VSA that the hospital treated with epinephrine. I would like to understand why we do not administer epinephrine for these patients.

thank you for your time

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Acetaminophen when NSAID contraindicated

Submission ID: 211


If a PT has a contraindication for NSAID is it acceptable to administer ACETAMINOPHEN for a PT experiencing severe hip pain?

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Central Lines and Interfacility transfers

Submission ID: 202


Can you clarify the expectation for the following situation: an ACP crew is doing an inter-facility transfer of a stable patient who has a central line (say an IJC) which is capped off/not actively running. The sending facility staff inquire if they have to send an escort due to the non-running central line. What would the answer be?

Can you clarify the expectation for the same patient, however the facility staff wants the line to be maintained TKVO?

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STEMI Bypass

Submission ID: 201


New 2017 STEMI bypass - In the RPPEO 2014 Powerpoint it states a STEMI must be recognized prior to a patient going VSA and subsequent ROSC in order to be considered for bypass. It does state "Pending Final Approval." The EHSB document states a contraindication is VSA without a ROSC but doesn't specifically state in the standard a STEMI must be identified before. Example would be patient goes VSA, is resuscitated and is now conscious complaining of chest pain, 12 lead indicates STEMI positive

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CACC administration of ASA and Cardiac Ischemia Medical Directive

Submission ID: 198


Dispatch has recently been instructing patients to take ASA for chest pain. If we arrive at scene and the patient has taken ASA already , are we to not administer our ASA for cardiac ischemia ? Sometimes the patient self administers a higher dose of ASA prior to our arrival if they do not have low dose ASA.

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