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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 Categories

Analgesia - acetaminophen admin

Question #: 347

Question:


Patient initially disqualifies for Acetaminophen due to time (taken 4 hours since the dose she had taken at home. Should paramedics give a dose once that 4 hour window has passed, assuming of course all other criteria are met?

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Broselow Tape vs ALS PCS doses

Question #: 345

Question:


What tools are allowed as reference for pediatrics?

My understanding is that the broslow tape is allowed and if the drug dose given differs from the ALS PCS, then it must be documented but is allowed and not considered an issue. But what about pedi stat? It came up in CME this past week that many medics use the app. However an example of a deviation from the standing orders would be that pedi stat gives a drug dosage of epi 1:1000 for down the tube, however the standing orders only allow a concentration of 1:10 000 down the tube.

Can you let us know how this would be considered from base hospital?

Many medics are still finding the app slow to load while on calls.

thank you,

Michelle

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Nitro doses when BP range changes during call

Question #: 277

Question:


Re: Cardiogenic Pulmonary Edema

In a patient with either IV access or previous Nitro use: Is the Nitro dose based upon the most recent blood pressure obtained, or the lowest blood pressure ever obtained (assuming the patient has always been >100 systolic and has never dropped more than 1/3 initial BP).

Ie:

Pt presents with BP 150/90 – first dose of Ntg will be 0.8mg

2nd BP = 130/80 – 2nd dose of Ntg will be 0.4

3rd BP = 144/90 – 3rd dose is 0.8 or still 0.4?

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EPI timeline for asthma - Pediatric

Question #: 275

Question:


Is there a specific timeline to administer epinephrine for an asthmatic 7-year-old?

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Patching - Chest Needle occlusion

Question #: 348

Question:


QPS and CEC team on behalf of Paramedics



Paramedic receives an order for a needle decompression, successfully places the needle and then it blocks. Does the Paramedic need to re-patch for an additional order to insert a second needle (same side beside the first one)?

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15-lead acquisition and STEMI bypass

Question #: 336

Question:


Would the RPPEO approve of paramedics performing a 15 lead ECG in the field (the posterior leads) and transporting a pt. to the PCI center if there is clear elevation present in V7-V9 ?

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Procedural Analgesia and TCP

Question #: 335

Question:


With the current analgesia medical directive being very broad, should the ACP consider using it in the setting of pain associated with ongoing TCP? Of course there is the sedation directive and midazolam, I was just wondering how we should approach things given the new, very broad, analgesia directive?

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Naloxone "conservative dosing" when administering SC/IM/IN

Question #: 331

Question:


Under the opioid toxicity medical directive there is no minimum dose mentioned for Narcan, only a max single dose of 0.8mg. Is it acceptable to give less than 0.8mg SC/IM/IN without a patch to BHP and document "conservative dosing" on the ACR?

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RVI: morphine vs nitro

Question #: 330

Question:


Why is the nitro a contraindication in the event of a Right Ventricle infarct but not the morphine?

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Morphine vs Fentanyl in the presence of an RVI

Question #: 329

Question:


I have a question about morphine in an inferior/right M.I. I know they're is no contraindication stated in the ALS for administering morphine in RVI, but in these situations would a patch to BHP for fentanyl be a better choice? This way you're not affecting they're blood pressure if they have never had morphine or are already boarderline with their pressure?

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Medical Directives App

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Ontario Paramedic Clinical Guide