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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

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MedicASK Categories

Most Recent Questions

Non-Paramedics determining Obvious Death

Question#: 688 Question: I have; over the years, been on scene with VSA patients who the first responding Fire Departments have termed Code 5. Sometimes there are certified Paramedic...

Thrombocytopenia and Ketorolac

Question#: 709 Question: Why is thrombocytopenia not a contraindication for Ketorolac administration but being on a blood thinner is? Answer: Thank you for this excellent q...

Bladder Irrigation During Transfers

Question#: 691 Question: No call number this time. I was questioned by a crew about transporting a pt. is undergoing bladder irrigation. (Large bag of saline, flushing the bladder vi...

Pharmacological Overdose Resources

Question#: 685 Question: I was just wondering if the RPPEO would have any resources for something like a quick reference for pharmacological overdoses? I understand we can call poiso...

Antiarrhythmic Choice

Question#: 694 Question: Amiodaron vs Lidocaine: My service uses lidocaine and I've have been asked a few occasions, why it is that we don't carry amiodaron. I understand the previo...

Dexamethasone Contraindications

Question#: 701 Question: Does the contraindication of parenteral steroids for dexamethasone include things like depo provera or testosterone injections? Answer: Testosteron...

AIV Responsibility of Care

Question#: 696 Question: Quick inquiry – is it expected practice that an AIV certified would assume pt care if there was potential or required need for a pt to have IV access initiat...

Pediatric Airway Equipment Dead Space

Question#: 688 Question: Question received from a paramedic in regards to the length of the "tree" (filter, ETCO2, tube extender) at the end of a SGA - iGel in our case - for pediatr...

Ondansetron Routes for 911/Palliative Patient's

Question#: 699 Question: Directive for administration of Ondansetron for Palliative Care says first route of administration should be 4mg PO, then SC, IV, CVAD. We've only ever carri...

STEMI Equivalent Bypass

Question#: 692 Question: With the release of the 2022 ACC expert consensus decision pathway for acute chest pain, will there be changes to the STEMI bypass criteria? Specifically for...

No Maximum # of Shocks in Cardiac Arrest

Question#: 695 Question: I have been hearing some conflicting info regarding the new Medical Cardiac Arrest directive for PCP's. I am hoping for some clear understanding regarding th...

Ondansetron Route

Question#: 697 Question: Wondering if there's a difference between Ondansetron in wafer form vs. disintegrating tablet? Answer: Both the wafer (dissolvable) and the tablet ...

Fentanyl for Cardiac Ischemia

Question#: 677 Question: Why Fentanyl is not replacing Morphine in our ischemic chest pain protocole? Fentanyl have a shorter onset, Fentanyl is probably causing less nausea and vomi...

Is ETT administration of salbutamol liquid appropriate?

Question#: 675 Question: Hi, I have seen endotracheal liquid bolus salbutamol several times in clinical settings with good effect, and have found a small but good study showing it t...

Should SGAs be avoided in patients with esophageal disease

Question#: 681 Question: Hi, I have a question concerning the contraindication in the Supraglottic Airway Medical Directive. The "Known esophageal disease (varices)" do also include...

Appropriate BP Site

Question#: 683 Question: Regarding obtaining a BP, is the standard the upper arm or can alternate sites be acceptable when considering a treatment plan? Answer: Taken on ma...

Pediatric airway options

Question#: 676 Question: Given that the success rate for intubations in the pediatric populations is low, the infrequency at which these skills are performed, coupled with the stress...

Antiemetic Administration

Question#: 680 Question: If Zofran is given first can Gravol follow after the half hour if pt. dosen't no improvement? Answer: Thank you for your question and for advocatin...

Dexamethasone Administration for Mild Bronchoconstriction

Question#: 671 Question: If a patient receives salbutamol for bronchoconstriction under the bronchoconstriction protocol and improves to a patient condition where they feel they are ...

How is dopamine used when presented as 200 mg in 5 ml rather than 200 mg in 250 ml?

Question#: 673 Question: Good Friday Morning: Within the equipment standards, it lists two options for Dopamine. Dopamine HCL Solution, 200mg/250mL or Dopamine HCL injection 200mg/5mL. I am...

Intranasal Dexamethasone

Question#: 666 Question: Can dexamethasone be used as a intranasal corticosteroids or do we strictly use the PO/IM/IV routes. Answer: As it currently stands, you are right in that the only...

Dexamethasone Route

Question#: 670 Question: With the definition of parenteral route being any route that bypasses the GI tract, does the contraindication for Dexamethasone (currently on PO or parenteral sterio...

IV Fluids in Cardiac Arrest

Question#: 659 Question: Is there any direction for IV bolus in medical cardiac arrest for PCP IV autonomous? The trauma TOR directive states we can give a bolus as long as it does not delay...

Why is naloxone not recommended in cardiac arrest associated with opioid overdose?

Question#: 662 Question: Regarding the use of Naloxone in medical cardiac arrest with suspected opioid overdose - I am curious as to the reasoning of Naloxone having “no clear role for routi...

May dexamethasone labelled for IM, IV or SC administration be administered orally

Question#: 665 Question: The new ALS PCS 5.1 adds Dexamethasone to the paramedic scope of practice. The treatment routes listed are IM/IV; however, it is used as an oral medical as well. Can...

Postural Vital Signs

Question#: 653 Question: When attending a witnessed syncope where the patient is now conscious, alert, and oriented, should the first set of vitals be taken before standing them? In what cas...

Is a "B52" appropriate for sedation when midazolam is ineffective?

Question#: 656 Question: I was sedating a combation non-oriented pt in order to get them to the hospital safely. They were on Clonazepam, which is probably why they didn't have an adequate s...

STEMI + and Transport to PCI Timeline

Question#: 663 Question: STEMI Bypass: From time of first +ve 12-Lead or Pt. Contact? A few of us seem to remember CME indicating STEMI bypass can occur if you can get to the PCI center with...

Is Epi appropriate for 55+ pt with suspected severe acute COPD with silent chest requiring BVM Ventilation & a Hx of Asthma?

Question#: 657 Question: I have a question with regards to the bronchoconstriction medical directive as it relates to COPD exacerbation. In a 55+ y/o pt with suspected severe acute COPD with...

Treatment of hypotension in Sepsis

Question#: 654 Question: Prehospital vasopressor (dopamine or epinephrine) for suspected suspected septic shock (infection with hypotension) following 20 mL/kg fluid bolus. This is a situati...

Should opioid analgesia be administered to a patient with opioid use disorder?

Question#: 648 Question: Opioid pain control for recovering addicts. What is the RPPEO stance on this? It could be severely detrimental to introduce opioids to someone currently in recovery...

Why is a normotensive SBP a condition for ketorolac?

Question#: 647 Question: Why is a normotensive SBP a condition for ketorolac? As a side note there is no SBP condition for Ibuprofen, which is also an NSAID Answer: The vital sign paramete...

PCP or ACP - For a CTAS 1 patient who is in the back of ambulance?

Question#: 579 Question: Hello, In regards to a PCP and ACP working together. If we have a return CTAS 1 patient what is the direction we are being given as to who is in the back. If the PCP...

Stroke Onset & Transport to Stroke Centre

Question#: 645 Question: Hi, I have a question regarding the acute stroke bypass, directly relating to an onset of greater than 6 hours. In my interpretation of the directive these patients ...

Cardiac Arrest Patient's With Internal Defibs

Question#: 642 Question: Should there be any deviation from normal practice when dealing with a patient currently in cardiac arrest.with a confirmed internal defibrillator ? Do we allow the ...

PCP's - How long would a patient have to be discontinued any anticoagulation therapy before considering them for NSAID treatment for pain?

Question#: 629 Question: Hello, I just had a patient whose blood thinners were temporarily discontinued due to an episode of hematuria. Although this patient was contraindicated for NSAIDs u...

Analgesia on Offload

Question#: 622 Question: I was wondering about the ability to utilize a mix of narcotics for our patients in light of the long offload delays that we are all now facing. In discussion with m...

Sodium Bicarb Administration

Question#: 632 Question: Is there any talk of placing Sodium Bicarb in the Cardiac Arrest directive with safety parameters in place of course so that the Patients who could possibly benefit ...

Trauma Bypass Question - Blunt Trauma VSA with a ROSC

Question#: 616 Question: When treating a pt who is VSA due to blunt trauma, if they remain VSA we transport to the nearest hospital. If we get a ROSC on this patient do we now divert as a tr...

Why can we administer CPAP for COPD exacerbation but not for Asthma?

Question#: 611 Question: In doing some research on CPAP I am coming across some information on the use of NIPPV for Asthmatics as well as the fact that COPD is as similar pathology as Asthma...

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