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NWRPCP MedicASK

Welcome to MedicASK. This section of the NWRPCP 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 NWRPCP. 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.

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

If you are unable to find your specific topic please complete the new question form.

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Latest MedicASK Answers

Nitro patch removal

Submission ID: 22

Question:

 

Hi there, I would like to inquire about whether or not there is a need to remove a patient’s Nitroglycerin transdermal patch prior to delivering Nitroglycerin SL under the Cardiac Ischemia or Acute Cardiogenic Pulmonary Edema Medical Directives. Much appreciated.

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Resuscitation with signs of obvious death

Submission ID: 23

Question:

 

Can you please provide direction on what would be the most appropriate action for situations involving the initiation of cardiopulmonary resuscitation by first responders, prior to Paramedic arrival, who is then deemed to meet the obvious death criteria under the BLS PCS.

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Clarification on oxygen delivery for COVID-19 Patient

Submission ID: 19

Question:

 

I just have a question in regards to oxygen treatment. With the recent memorandum it states that in all cases high flow oxygen delivery should be avoided unless via ETT/SGA. Does this mean we are no longer able to use a BVM for a patient who is severely short of breath when a high concentration/low flow masks with a submicron filter is no longer able to maintain an appropriate 02 saturation level?

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Clarification on COVID-19 memorandum on Treatment Considerations

Submission ID: 17

Question:

 

As per the new amendments that came out today are we with-holding CPAP (in all cases) including those who screen negative for COVID-19 assuming that they could still be a positive case?



Some clarification is required.

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BHP Webinar

Submission ID: 16

Question:

 

On a recent webinar Dr. Exley cited two examples of orders a BHP might give that should not be followed because they are out of the scope of practice. One was an ACP getting an order for Atropine for a cholinergic overdose.



My question is just to clarify this point...



Am I to conclude that if I have a patient exposed to Organophosphates or Carbamate or Herbicides who is experiencing severe S&S of a cholinergic OD (Hypotension, Bradycardia, SLUDGE), that I CANNOT contact a BHP and ask for Atropine or carry out the order if a BHP orders Atropine?



My confusion stems from a belief that I have always been able to perform this procedure and because the Medical Directive for Adult and Paediatric Nerve Agent Exposure calls for the administration of Atropine at given doses based on whether the patient's condition is moderate or severe:



Adult 2 - 6 mg

Ped. 0.5 - 1 mg/kg



I appreciate the time taken in providing me with an answer, and look forward to hearing from you.









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ASA

Submission ID: 4

Question:

 

Just have a question about ASA in regards to administering the drug for new onset cardiac ischemic rhythms. An example would be a patient in 2nd degree type 2 heart block with no other cardiac ischemia signs/symptoms but has no history of a heart block before medics completed an assessment on the patient. With the possibility of the heart block being caused by ischemia can we give ASA ? Other cardiac rhythms that could be treated with ASA because of possible ischemia are BI/ Trigeminy PVCs/ runs of vtach/ 3RD degree block with no pervious history until medic assessment on scene.



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Analgesia Medical Directive Question

Submission ID: 1

Question:

 

This question is regarding the indication for the new analgesia medical direction. The new indication is just "pain" with a contraindication of suspected cardiac ischemia. I am aware of plenty of situations where this protocol would be appropriate. Example a fracture extremity or hip, renal colic, acute muscle strain, burns or etc. My main concern is what would be considered an appropriate type of pain to receive our analgesic medication or can we now consider all types of pain appropriate as long as it is not suspected cardiac ischemia?

The protocol/companion document do not mention other types of visceral pain. Can someone with acute/chronic abdominal pain be treated with our analgesic medication? Example appendicitis or pancreatitis.

Does the origin of the pain need to be traumatic in nature? Example a pt has an acute infection in their limb or a possible DVT causing extreme pain.

What about a pt with a possible fractured rib or traumatic neck/back injury?

Headache/migraine?

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