Question: Paediatric Cardiac Arrest: is there direction to start compressions on paediatrics with HR 60 with signs of poor perfusion?

Question: Hello, During a recent transport lasting over two hours, a patient’s suspected ischemic chest pain resolved following nitroglycerin, then recurred. I restarted nitroglycerin as all the directive conditions were still within the necessary clinical parameters. I could not find specific guidance on recurrent episodes in the current Cardiac Ischemia Medical Directive. Could you clarify whether each recurrence after complete symptom relief can be treated as a new episode and also that the applicable nitroglycerin dose maximum of 6 also remains the same. My previous experience and understanding was that a new episode could be treated with a new dosing sequence. Look forward to your help. P.S. Related: If a patient with STEMI were to achieve symptom relief with the maximum 3 doses of nitroglycerin, but symptoms subsequently recur, can nitroglycerin likewise be restarted with a fresh 3-dose maximum, or is the 3 maximum an absolute limit in STEMI circumstances?

Question: CPR ratios for paediatrics Neonatal resuscitation is 3:1 ratio. Paediatric resuscitation is 15:2 (2 rescuers) and 30:2 (1 rescuer) I know the directives have changed but is there still a >24 HOURS to 28 DAYS a CPR ration of 3:1 and selected j/kg as per ALS PCS. The BLS states follow the heart & stroke guidelines. BLS H&S Guidelines state infants (age less than 1 year, excluding newborns AND paediatrics (age 1 to puberty): non-intubated: ratio 15:2 as above. Intubated: Gave 1 breath every 2 to 3 seconds Neonate: both non-intubated AND intubated 3:1 ratio as above.

Question: Capacities On International flights and domestic. Often paramedics may be called for help on the plane. Apparently it happens quite frequently. Just happened to me. What capacities do we have? Air Canada has their own Doctor on Call through a sat phone and sometimes he can ask us to perform delegated acts. Heard they'll ask paramedics for pronouncements or help with treatment. Do we take directions from them? They'll ask for our OASIS & contact you afterwards apparently. I would assume we act under good samaritan act since we're off-duty. They do have a pelican case full of equipment for vitals and looks to be about 20-30 vials of drugs. Is it under your license, their docs license or Good Samaritan? It's a grey area and a weird situation where we might not know what to do and how you want us to act? Can you explain in detail all that we may encounter and what we should do? International flights in other countries? Thank you for your time.

Question: Hello! With regards to hypotension in a trauma patient secondary to blood loss. I recently reviewed in a text book that giving a hypotensive trauma patient a 0.9% normal saline fluid bolus can be detrimental to the patient due to its acidic properties as the patient is already going to be in metabolic acidosis due to the anaemia. With that being said and during a longer transport time where ORNGE is not available, can this be considered the benefit of fluid bolus would out weigh the negative impact on the patient as we should be trying to maintain perfusion to the vital organs until we arrive at the closest ED? Should a patch to a base hospital be considered?