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RPPEO MedicASK

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

MEDICAL DIRECTIVES

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Most Recent Answers

Lower dose of Ketamine for certain patients

In regards to the removal of patch in the combative pt MD, do the same guidelines (treating pt with lesser dosing when unable to rule out other reversible causes) apply to Ketamine as it does to Midazolam? It seems like since the removal of mandatory patch BH has been explicit about the approach t…

Combative Patient

Medication Checks and Verifications

Hello, I would like to have a clarification regarding a BHP expectation. It is my understanding that during an intervention and the administration of medications, the BHP expectation is the use of best practices to avoid errors of dosage among others. Does the BHP expect the two paramedics to calc…

Paramedic Practice

Prehospital PRAM Score Use

I'm interested in having some contact/education regarding the use of PRAM scoring in pediatric respiratory cases and how it can be applied to the prehospital setting.

Bronchoconstriction

CPAP Use With Pneumonia

I've done a few calls with pt complaining of SOB with some crackles on one side of their lungs. With other signs and symptoms, we concluded it is probably a pneumonia, and I was wondering if they met the criteria for CPAP is it a good thing to apply it to them? I've heard different response such a…

Pediatric Nasal Suctioning

26 February 2025

Are we allowed to do nare suctioning or nasal suctioning past the hypopharynx for pediatrics with bronchiolitis?

Paramedic Practice

ICD Deactivation

26 February 2025

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…

Paramedic Practice

STEMI contiguous leads

25 February 2025

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…

Paramedic Practice

Topping Up Patient Medications

11 February 2025

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

Paramedic Practice

Ketamine for Analgesia Dosing

11 February 2025

IV dose, 17 years and 364 days old, maxes out at 40kg (10mg) (... or just 17 years old so I'm not being pedantic.) IV dose, 18 years old, is now 20mg. (2x dose) IN dose 17 years and 364 days old maxes out at 30kg (30mg) (... or just 17 years old so I'm not being pedantic.) IN dose 18 years old i…

Patch Requirement for Combative Patients

07 February 2025

With regards to sedation for combative patients. Do we have to have a patch order to give Ketamine or do ACPs have a choice to use either Midazolam or Ketamine?

Combative Patient

CPAP and Asthma

31 January 2025

Why is asthma listed as a contraindication for CPAP? I understand how it may not be the first thing to reach for in an asthma exacerbation, however more often than not I hear about older patients getting CPAP withheld because the medic was informed of a history of asthma alongside a diagnosis of C…

Can a patient in Cardiac Arrest have a gag reflex?

30 January 2025

we had a male pt who had been trapped in a car at an mvc. pt had vitals, and was grunting. pt became vsa post extrication. when an opa was attempted there was a loud gag reflex. is this possible? was it a true gag reflex?

Methoxyflurane Use and Pregnancy

30 January 2025

With the current Methoxyflurane trial in some jurisdictions, there seems to be a lack of information regarding safety of paramedics with regarding to inhaling patient's exhaled medication. Particularly with regards to pregnant paramedics, as pregnancy is a contraindication for the patient themselve…

STEMI Bypass and Patient Contact Time

29 January 2025

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.

Patient Transport & Disposition

Pain management in pregnant patients

24 December 2024

When discussing pain management options with a pregnant female (approx 6-8 weeks gestation), the pt denied offer of narcotics due to fear of harm to her fetus. I empathised with her concern, and celebrate her strength, but not successful in helping her understand that the pain management I was offe…

EXTUBATION

23 December 2024

Can ACPs extubate a patient ? I recognize that we have sedation protocols to keep them intubated - but under some rare circumstances (spontaneous return of mentation under various conditions) I am assuming we can extubate the patient? We can't find any literature stating yay or nay for Ontario.

POA/SDM Determining Transport Destination

20 December 2024

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…

Patient Transport & Disposition

ASA Admin

09 December 2024

The new MPDS dispatch system is advising patients to take their own ASA at a dosage of 320mg when they call for chest pain prior to paramedics arriving. Should we continue to give our own ASA if this is the case and we suspect ischemia?

Cardiac Ischemia

Intervening on a flight

09 December 2024

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…

Paramedic Practice

Disclosing Information

27 November 2024

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

Paramedic Practice

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