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RPPEO MedicASK

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.

Medical Directives

MedicASK questions that have been answered by the RPPEO are posted below.

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Recent MedicASK Answers

CPAP with Pneumonia and COPD

Answer:


CPAP should be considered when the paramedic suspects a working diagnosis of Pulmonary Edema or COPD exacerbation. These are often identified by adventitious lung sounds (ie crackles and/or wheezes respectively). Further, CPAP should be considered as an additive therapy rather than the main tool to assist with dyspnea.

In the context of pneumonia, the patient care goals are different; it is not recommended to routinely use CPAP for pneumonia.

The care goals associated with management of pneumonia in pre-hospital/out-of-hospital settings are oxygenation, early transport (time to antibiotic administration), and possible fluid administration for dehydration or sepsis.

Disease process and exacerbation can be difficult to distinguish in pre-hospital/out-of-hospital settings. If the patient still experiences dyspnea even after oxygenation targets (BLS PCS Oxygen Therapy Standard) are reached and you believe the etiology may be COPD exacerbation, we recommend a consult with a Base Hospital Physician to establish a treatment plan that is safe and tailored for your patient.

Further information on pneumonia, pulmonary edema and CPAP:

Pneumonia is an infectious pathology while pulmonary edema is not usually caused by an infection. It is a marker for a more severe underlying systemic pathology like heart failure or volume overload.

Pneumonia can cause pulmonary edema as the inflammatory state in pneumonia can cause leakage of fluid from the blood vessels and capillaries thus causing massive collection of fluid in the lungs that give an appearance like that of pulmonary edema. When the patient reaches this point, it is very unlikely that the parameters for safe use of CPAP will be met.

Further information on pneumonia, COPD and CPAP:

CPAP does not treat pneumonia directly, however it can reduce the work-of-breathing often seen with other underlying respiratory diseases such as COPD.

MedicLEARN:

More information on compliance, resistance, CPAP and COPD can be found on MedicLEARN: https://mediclearn.rppeo.ca/course/view.php?id=225

Pediatric Bradycardia with a Pulse

Answer:


As management of pediatric bradycardia with a pulse is not currently in the ALS PCS, we recommend to consult with a Base Hospital Physician to discuss a management plan using the AHA Guidelines in your recommendations.

You can find the latest 2020 AHA Guidelines on the following website: https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf

Here are the highlights of the 2020 AHA Guideline for Pediatric Bradycardia with a Pulse:

If patient is bradycardic and presenting with cardiopulmonary compromise
Start with airway management, oxygenation and ventilation
If HR 60 despite oxygenation/ventilation
Start CPR
If Bradycardia persists
Continue CPR and monitor pulse q 2 min
Obtain vascular access (IV/IO) or ETT if IV/IO unavailable
Consider EPI IV/IO/ETT
IV/IO: EPI 0.1mg/ml concentration: 0.01mg/kg
ETT: EPI 1mg/mL concentration: 0.1mg/kg
Consider Atropine IV/IO for increased vagal tone or primary AV block
0.02mg/kg
minimum single dose: 0.1mg
maximum single dose: 0.5mg
Consider transcutaneous pacing
Identify and manage other possible underlying causes such as:
Hypoxia
Hypothermia
Medications / overdoses

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