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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, the ALS or BLS Patient Care Standards or Companion Document for the Advanced Life Support Patient Care Standards. If you are unable to find your specific topic please fill out the form below.

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MedicASK Answers

Oxygen Administration for Cardiac Ischemia

Submission ID: 216

Question:


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

Question:


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

Question:


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

Question:


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

Question:


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

Question:


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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Cardioversion Joules settings

Submission ID: 197

Question:


What are the cardioversion values for Zoll X? Standing orders indicate starting at 100J then 200J then max value. The ZollX only charges to 200J. I can not find the answer in the Zoll X manual, Zoll's internet site or in our standing order for tachydisrythmia. I believe the standing order in our Medical Directives is referring to Medtronic LP defibrillators only.

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Narcan routes/doses

Submission ID: 192

Question:


Regarding the Opioid Toxicity Medical Directive:

Is there a recommended amount or scale that we should consider giving, or should we always administer the maximum dose of 0.8 mg?

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Narcan routes and doses

Submission ID: 190

Question:


When managing Opiod Toxicity, can less than 0.8mg be given as a single dose? If so, is there a minimum dose? Can you give 3 doses all at different amounts?

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Narcan routes of administration

Submission ID: 189

Question:


When administering naloxone is it acceptable to give the second dose by a different route? ex: if the first dose was I.V could the second dose be S.C? or if the first was S.C and didn't work as fast as expected could the second dose go I.M? (For ALS PCS 4.0 July 2017)

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