MedicASK Answers
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If our patient has DKA, should we encourage patient insulin administration?
771
I recently attended a call for a 30 y.o. in DKA. The patients BGL registered as "high", he was exhibiting kussmaul respirations, hypotensive, intermittently bradycardic and GCS 3. We later found out from hospital staff that pts PH was 6.75. I am aware that the treatment plan in hospital was an ins…
PCP or ACP - For a CTAS 1 patient who is in the back of ambulance?
579
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 is comfortable being in the back and the care the patient is receiving is something within the PCP scope could they be in the back…
Could you please define the TBI contraindication for NSAID administration?
Patient Care
NPA use in mid-face and/or basal skull fracture patients
820
Is an NPA contraindicated with suspected mid-face or basal skull fracture?
Retained Products of Conception and Miscarriage
743
We had a patient that had a miscarriage this am, she was 3 months gestation. She had started to have vaginal bleeding 4 days ago. She was examined at civic on Saturday, after an ultrasound was informed that there was no heart sounds. My partner informed me that we needed to retrieve the tissues in…
Joint Reduction/Manipulation
726
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 statu…
May the Canadian C-Spine Rule be applied in patient assessment
708
Just a question in regards to spinal immobilization. Is it still acceptable to apply the Canadian C-spine rule? Or was that just a temporary study and we should now revert to the BLS SMR standard?
Pharmacological Overdose Resources
Pedi Stat App
732
Just wanting to confirm if the Pedistat app is a recognized resource by the RPPEO i.e. for pt weight, ETT size/depth etc.
PCP Manual Defibrillation
717
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 w…
Bladder Irrigation During Transfers
Inter-facility transfer of chest tubes
STEMI Bypass and Patient Contact Time
866
We have had some debate regarding STEMI bypass. We are looking for clarification of pt contact. Question is, when you have a PRU attending and are first on scene, are we using their pt contact time or the transporting crews pt contact time.
POA/SDM Determining Transport Destination
862
Can a person with power of attorney (POA) make a destination decision when a bypass is clinically approved? I recently encountered a situation where an elderly Pt who could not make decisions on their own had experienced trauma that fit the trauma bypass criteria, but the POA who was on-scene reque…
CTAS 1 and STEMI Bypass
784
I wanted to follow up on clarification of STEMI bypass and our CTAS level, in our companion documentation it shows a STEMI should be a CTAS 1 but our guide for bypass says a CTAS 1 is contraindicated and the paramedic cannot secure airway or ventilate. Is this pertaining to you can still go back on…
Trauma Timelines
738
Working for Cornwall SDG, our trauma bypass have amendments extending our transport time from 30 minutes to 60 minutes. In the contraindication for Trauma TOR, it states “patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital < 30 min transport away”. Does this 30 m…
Professionalism
PHIPPA and Death
779
I am curious on the PHIPPA guidelines surrounding a deceased patient that may be known to the paramedic's social circle. I appreciate that protecting patients health information is critical during 911 calls, does that change if the patient has died? For example, paramedic responds to a VSA in the…
Sharing of Personal Health Information
753
If a minor has harmed themselves (I.e. ingestion of drugs) what role does the parent or legal guardian have if the pt does not give consent to disclose information? RN at CHEO and PD stated parents MUST be notified. How does PHIPA apply to these situations?
Age of Consent
745
What is the minimum age that a patient needs to be to refuse treatment and transport to hospital?
Paramedic Incident Reporting Requirements
882
Does the RPPEO require paramedics to complete IRs for any type of calls? There is a belief they are required an IR for all VSA, is this correct? Or is an IR required only if the patient is not transported? I have looked through your policies and cannot find any reference to my question above as w…
DNR validity
856
In relation to DNRs: If both treatment option boxes are checked, does that invalidate the DNR?
Is continuous normal ECG data required to be documentation on the ACR
817
With rhythm analysis, if the initial one added to the ACR is normal, and throughout the call/transport, if the rhythm remains normal, do you have to continue to upload the ECG to the call to show it continues to be normal, or is the initial rhythm plus documentation it remained normal enough?
AIV Documentation - Concentration
798
I was going over the PCP AIV package. In documentation, it states you have to document the drug concentration as well as dosage and route. In the ACR completion manual (version 3.0 2017), there is no mention of the need to document concentration. Is this an RPPEO requirement?
Pediatric Nasal Suctioning
886
Are we allowed to do nare suctioning or nasal suctioning past the hypopharynx for pediatrics with bronchiolitis?
ICD Deactivation
884
A friend of mine is a MD in palliative care. In the recent few months three of her patients were discharge home for end of life with a still functional ICD. In all cases patient wanted the ICD disabled once they realised it would prolonged their agony. The nurse working with her were unwilling to a…
STEMI contiguous leads
883
My colleagues and I are not all on the same page. When looking at an ecg and looking for elevation in "2 or more contiguous leads" would v2-v3 count as contiguous, same idea for v4-v5 or are we only grouping (v1/v2, v3/v4, v5/v6/1/avL, 2/3/avf). Are we considering v4-v5 contiguous as they both look…
Topping Up Patient Medications
877
When arriving to a patient that has taken a medication prior to Paramedic arrival but not full dose - for example only 325mg or 500mg Tylenol - are we to not administer any more Tylenol or are we expected to top up the dose to a full 975mg? Same question for Advil, Benadryl, Gravol etc
Disclosing Information
860
I had a pt confess to a serious crime while intoxicated. Would it be appropriate to pass on this information to the appropriate police force? Not including any patient medical history obviously
Intervening on a flight
855
Recently, I had to intervene on a plane during a transatlantic flight for an elderly patient who first appeared to be VSA in her seat. I was the most qualified medical professional on board. I was provided their emergency kit, and tried to figure out what equipment was available. They were well sto…
Heated blankets for hypothermic/trauma patients
834
What is RPPEO's stance on the use of one time use heated blankets, with patients who are either hypothermic, or have suffered multi-system trauma?
Do we need to reassess patients in an MCI?
811
In the case of an MCI where one (or more) patients are VSA, when patients are initially triaged as "black" and do not be the criteria for obviously dead, should resuscitation be attempted if/when enough resources have arrived on scene?
Palliative Care Medications
795
Can you administer palliative medications to a palliative pt. if transport to hospital has been initiated? Does this require a patch? Is this applicable for any/all palliative meds or only select ones? Can you patch to administer palliative meds to a patient on the 911 side who isn't palliative.
Rigor Mortis
766
My question pertains to obvious signs of death, and specifically with respect to rigor mortis of the smaller muscles of the face. I recognize the standard for obvious signs of death as documented by the RPPEO is "gross rigor mortis" ie stiffening of the limbs/body. However, given that the onset o…
BHP's Delegating Transport Destination
838
When patching to Base Hospital, can the Physician direct the crew to a specific destination when no bypass agreements/criteria have been met?
Patching to a BHP While Working for a Private Company
830
I'm employed as a PCP within the RPPEO. I work a second job with a private event EMS company with the full scope of practice of a PCP. We have a medical director, but he is not readily available by phone. If I was working a shift at this private company, would I be allowed to call a base hospital…