Most Recent Answers

Just wanting to confirm if the Pedistat app is a recognized resource by the RPPEO i.e. for pt weight, ETT size/depth etc.

Once Zonfran have been given to someone who is over 65 and it is not relieving the N/V after 30 mins, would it be appropriate to give 25mg of Gravol at this point even though they are over the age of 65? I understand why we do not want to give it right away. Thank you, I look forward to hearing from you soon.

My question is about dual sequential defibrillation.

My service was part of dose vf study which I received training on. I noticed in one of the medic news posts they mentioned paramedics who received this training are able to continue to perform VC and DSED on patients in refractory vf and vt. I’d just like to clarify if this is something we can do independent of BHP consultation or if calling a BH is still preferred? And if so is it recommended to go straight from A/L pads to DSED vs VC? Is it best to do 3 initial shocks before changing or is it appropriate to do so sooner?

Would RPPEO consider education on joint reductions/manipulations?

Under the BLS, in Extremity Injury Standard (page 125 1. f.) it states, "If adequate circulation/sensation is absent, after splinting and re-manipulation is possible, gentle re-manipulate the extremity to restore neurovascular status."

I understand reduction would most likely be a delegated act, but with long and painful transfer times with pulseless or neurovascular compromise, is this something that is foreseeable in the future? Is it possible for you to supply references or educational content on how we are suppose to manipulate joints safely under today's standard?

If you have a ROSC with bradycardia and hypotension that's not responding to Dopamine, at what point may TCP be considered...after Dopamine is maxed out at 20mcg/kg/min? Dopamine is increased q5 minutes.

My question is in regards to drop sets, specifically 10gtts vs 60 gtts for pediatric patients.

It was my understanding that fluid administration for the pediatric pt was best done/should be done with a 60 gtts set and to not use a 10 gtts for peds.

Is this an absolute rule of practice for pediatric patients or can discretion be used by paramedics?

In certain circumstances using a 10gtts would appear to be much easier to maintain accurate/appropriate flow rates.

My questions refers to the trauma cardiac arrest protocol, more specifically the trauma TOR. In the latest version of the ALS PCS (5.1), a new contraindication for a Trauma TOR is as stated "patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital <30 min transport time away". This includes patients who are asystole. I am curious if there is any additional insight/rationale for why these changes were made for the asystole patient (I wasn't able to find anything specific in the ALS PCS supporting documents). Thank you in advance.

When on a stroke code, does the Base Hospital want medics placing more than one IV line?

As a PCP in my service for Medical cardiac arrest i am required to utalize the Analyze button on our monitor instead of manual interpretation. When asking my service why they state the BH doesnt want it, when asking at BH CME's im informed my service does not want it. I am slightly confused as to why as a PCP i can interpret a 12-Lead ECG, Dx a STEMI, bypass multiple ERs and go directly to OHI with no consulting of a physician or ACP but i am not allowed to differentiate VTac or Vfib from a Non-shockable rythems. Is there any considerations in the future to allow PCP's in Ottawa to use Manual Defib.

When preparing medication, for example IM Midazolam for a 36kg pt, the 0.2mg/kg dose would be 7.2mg. Using a 5mg/ml concentration that would be 1.44ml volume of medication. Using a 3ml syringe, I would only be able to accurately measure 1.4ml dose.

Is it acceptable to round down the dose in this circumstance? In this case rounding down to 7mg to allow accurate dosing?

With palliative care directives now becoming a core directive, what is the RPPEOs stance on using these medications for general practice. Examples include: using hydromorphone for pain management for someone who has previous hx of hydromorphone use, ondansetron IV as opposed to SL (we still are on back order for ondansetron at our service and have none in the wafer form as of yet), haldol for sedation in a PCP scope of practice setting.