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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.

For answers related to COVID-19, see our COVID-19 Question & Answer Forum.

You may continue to submit your questions related to COVID-19 in MedicASK.

Answers are only posted in the COVID-19 Question & Answer Forum.

We are answering these questions as quickly as possible and updating answers regularly given the speed at which the pandemic is evolving.

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CPAP - Medical Directive vs Sleep Apnea

Question #: 406

Question:


What is the difference between home CPAP for sleep apnea and CPAP we carry/our medical directive? Why can people with sleep apnea can use CPAP while sleeping (not sitting upright) and our medical directive doesn't allow (contraindication if patient cannot sleep upright)?

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Dopamine discontinuation - from ROSC to VSA

Question #: 381

Question:


In the event of a rosc and I'm running a dopamine infusion where my patient re arrests, should I still discontinue dopamine over 5-10 minutes at this time or immediately?

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COVID 19 considerations - EPI interval - bronchoconstriction

Question #: 389

Question:


For the COVID considerations it says to consider IM epinephrine as per the bronchoconstriction medical directive to a maximum of 2 doses. What would the dosing interval be?

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Gravol admin if patient self-admin and still nauseated

Question #: 371

Question:


Can a Paramedic administer Gravol to a patient even if there is previous self-administration, but the symptoms are still present? Is it considered an overdose?

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Opioids, analgesia and pregnancy

Question #: 366

Question:


Should we withhold narcotics to treat a pregnant patient for pain management?

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Adenosine administration when BP 90-100

Question #: 370

Question:


Tachydysrhythmia- conversation with ACP's regarding Adnenosine. Case in point, ACP treated patient with 6mg IVP, no change in rhythm but the BP dropped to 96 systolic. This patient fell into the zone of no more adensone and was not hypotensive (less than 90) for PATCH cardioversion. Minutes later patient normal tensive...can you treat again with adenosine or is it the same as once your out your out?

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Nitro admin and Inferior Wall MI

Question #: 361

Question:



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 right side and it was negative. His pressure was systolic 160 . I gave the pt so e ASA but was confused if Nitro should of been given therefore I didn't give any. We were both PCP . Should Nitro be given if the 15 lead is negative? And follow the STEMI protocol?

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Pulmonary Edema, Cardiac Ischemia and Nitro

Question #: 360

Question:


When it is determined the patient is experiencing cardiac ischemia and also presenting with acute pulmonary edema (IV established, BP over 140) should the treatment plan only include 0.4mg doses of nitro x6 and try CPAP? Or can nitro be administered to the 0.8mg as stated in the edema directive? My opinion would be to only treat with 0.4mg nitro.

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Verbal DNR and BHP patch

Question #: 359

Question:


VSA patient with a verbal DNR from spouse. In a PCP/ACP split crew situation would the expectation be for the ACP to do the patch to the BHP to authorize the honouring of the verbal DNR or can it be either crew member depending on whom is most available in the situation? Basically, should the ACP generally be patching even if it is for things within the PCP scope of practice "just in case" the BHP wants to discuss other, expanded treatment options?

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Stoping to analyse

Question #: 357

Question:



In the event of a medical arrest (pcp semi automatic - no manual mode) , if it is decided that it fits a special circumstance and transport is initiated after the first analysis, is it expected that a pcp would pull over and complete the remaining 3 analysis en route, or continue direct to closest hospital and discontinuing the remaining analysis. And is the answer different if the patient is in a shockable or non shockable rhythm.

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Medical Directives App

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