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Analgesia Medical Directive Question

Submission ID: 1



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?


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15 Lead ECG and Nitroglycerin Clarification

Submission ID: 4



As per NWRPCP, if there is ST-elevation in the inferior leads (II, III, aVF) we are automatically out of our Nitroglycerine protocol despite determining if has right ventricular involvement. This has lead me to believe that we shouldn't perform a 15-lead to determine symptom relief administration. If we have a normal ECG but notice depression in V3 & V4 (anterior leads), and we perform a 15 lead to check for reciprocal changes that might indicate a posterior STEMI? Are we indicated to administer nitroglycerin for a posterior STEMI that doesn't have V4R involvement? My understanding is that V4R determines if the right ventricle is involved so if V4R is normal, wouldn't we just have a normal posterior MI?

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Submission ID: 4



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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