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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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EPI administration - Cardiac Arrest

Question #: 319

Question:


In the event of a ROSC followed by a rearrest is an ACP medic to continue administering EPI every 4 minutes or are we only to do the one analyze and continue CPR till receiving hospital? I seems like epi could be beneficial to the pt in re arrest as well as potential amnio however the directive nor the companion document seem to answer this question.

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Nebulized ventolin concentrations

Question #: 318

Question:


Nebulized ventolin.



I have worked at two other services which ONLY carried Ventolin 2.5mg/2.5ml. to get the adult dose of 5mg we just used 2x2.5mg/2.5ml



Here in Ottawa, we carry both 2.5/2.5 and 5/2.5 concentrations and I had a partner tell me we are supposed to only use 5mg/2.5ml for adult admin as it is due to higher concentration and my partner was telling me I am being a detriment to my patient by using 2x 2.5mg/2.5mls as it takes twice as long to take effect. (According to partner)



My question is does it matter which way we administer it if it is the same dose? And both ways meet our protocol technically.



Me personally, I have always felt like I wanted it to last as long as possible hence why I like using 2.5mg in 2.5ml as it gives you 5mls of solution. which is why we only carried that at the other services as we had long transport times.

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Medical Cardiac Arrest - Single PCP responder on scene

Question #: 316

Question:


As a First Response PCP (PRU or Sierra) if I am on scene with a VSA and I perform a shock for V/F or V-Tach and I end up at the end of my protocol (3+1 analysis) and the PT remains VSA and no transport crew is on-scene yet, should I just continue doing analysis every 2 minutes until they arrive? (Other first response agencies use this as their protocol until ambulance arrive).



Obviously this would change if I hadn't gotten a shock and I had to concider a medical TOR after my 3+1analysis.

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Hypothermic VSA - defibrillation en route

Question #: 317

Question:


While transporting an hypothermic VSA that had been initially defibrillated, if the next presenting rhythm enroute is shockable, should I ignore it or defibrillate without causing delay.?

The medical directive puts the max # of shock at 1 ...

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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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Medical Directives App

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