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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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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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Premature Neonate Resuscitation

Question #: 324

Question:


I recently noticed that the age at which an extremely premature neonate is to be assumed to be viable has been removed from the BLS standards. Can the RPPEO provide us with written direction as to what gestational age above which to attempt resuscitation? A clear guideline could be extremely helpful in guiding our actions on these sensitive calls.

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Maximum # of Nitro doses

Question #: 325

Question:


For patients complaining of Ischemic chest pain, you choose to treat with Nitro as they meet all protocol criteria, including NO right sided involvement and STEMI negative on the 12 Lead. After administering for example, 4 sprays of Nitro, the patients discomfort fully resolves. While enroute to hospital, patient states that the discomfort has returned. The patients presentation as well as their vitals still fall under the protocol. Are we able to start the dosage from the beginning and give another 6, or are we now only able to give 2 (4 from previous episode + 2 more to equal 6 TOTAL). Cant seem to find anything in the protocol or companion document that speaks to re-onset of discomfort.

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EPI ETT administration - Cardiac Arrest

Question #: 334

Question:


In the case where vascular access CANNOT be established, could the base hospital clarify what the recommended solution of epinephrine should be when administering endotracheally during a cardiac arrest.

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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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