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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

POC Urinalysis

30 September 2025

Would RPPEO disapprove of medics using CP tools and assessments during CTAS 3,4,5 calls? Ie. POC urinalysis to rule out/in UTI, or to detect ketones in suspected DKA? I understand we would obviously still need to transport and not delay scene time to complete the tests / assessments.

Paramedic Practice

Dexamethasone Route - Why PO?

29 September 2025

Why is the preferred route for Dex listed as PO/IM/IV? When you take into account "First Pass Metabolism" by the liver and IV being 100% bioavailable, would the IV route not be best for our patients?

Paramedic Practice

PCP Special Directives

19 September 2025

Would it be possible to establish a Special Directive allowing Primary Care Paramedics (PCPs) in Special Operations to administer Calcium Gluconate and Salbutamol for the management of suspected hyperkalemia, particularly in the context of suspected crush syndrome? PCPs are already authorized to a…

Tendon Stretch Reflexes

19 September 2025

What is the relevance of tendon stretch reflexes in the prehospital environment, and is it within the paramedic's scope of practice to assess or elicit tendon stretch reflexes? I understand that focal hyporeflexia can be a useful diagnostic tool in acute stroke or SCI patients but I am curious as t…

Paramedic Practice

Verbal DNR from Patient

16 September 2025

In the event of a patient going VSA on scene/route. If the patient verbally expresses that they do not want to be resuscitated but do not have a valid DNR filled out, do we honor this in the event of cardiac arrest? Furthermore, if on scene and a patient states they have a valid DNR but the paperwo…

Nitro and Morphine Dosing Interval - Cardiac Ischemia

03 September 2025

Can nitro and morphine be co-administered for treatment of cardiac ischemia?

Cardiac Ischemia

SIRS/Sepsis parameters

03 September 2025

It was recently brought to my attention that within the OBGH app under Medical References, the sepsis notification tool in the RPPEO region does not follow the evidence-based criteria for SIRS (for HR and RR). Is there a rationale behind this?

Paramedic Practice

Opiates and Ketamine for patients with OUD

We just transported a 38F with abdominal pain x2 days. Known recreational narcotic user. Has been on methadone for a lengthy amount of time - possibly years. Mom on scene came out and without emotion, told us she asked her daughter to put some pants on and come outside. When the pt came out the fr…

Adenosine Preload vs Vial: Tips for Admin

Due to recent challenges with stocking the 6mg and 12mg Adenosine preloads, our pharmacy supplier has provided Adenosine 6mg/2ml (mg/ml) vials for rapid IV bolus use. We're reaching out to seek your input on best practices for preparing and administering this formulation in a way that ensures rapi…

Tachydysrhythmia

Gravol for patients ≥65

Are we now authorized to administer Gravol to patients 65 and older without a patch? The ALS PCS states “If Zofran is NOT available…” and the Companion Document doesn’t address this.

Allergic Reaction

ASA for SVT

I was advised a year ago now from a medic that works with the RPPEO that we should be giving all patients in an SVT ASA. Recently, I was told by a second medic with the RPPEO that we should in fact be giving ASA to SVT patients, but specifically in regards to global subendocardial ischemia. I was j…

Tachydysrhythmia

Treatment based on transport decision

Is there communication regarding whether treatment should be held or proceeded with prior to transport decision making? I understand some medications are non-negotiable, however with some of the oral or IM meds, the potential for refusal of the pt is there after giving the meds. Does a BH Patch suf…

Patient Transport & Disposition

Acetaminophen for Fever

When it comes to acetaminophen administration, our medical directives state it is only to be used in the setting of pain as an analgesic. Why isn't there an inclusion for it to be used as an antipyretic to help control febrile patients? Some parts of the province are doing trials on prehospital sep…

Paramedic Practice

Suboxone Patch Removal

In light of the recent article published by Dr Austin and Dr Froats in CJEM on the urgency of the opioid crisis and some of the barriers both paramedics and our patients face, where do we stand on potentially removing the regional patch point for Suboxone administration?

Opioid Toxicity

Bougie through Suction Catheter

My question is about the new advisory against using a Bougie through suction catheter. I agree with you that it should absolutely not be a routine practice. Inserting a Bougie through the suction catheter should be an almost last ditch effort before FONA, but that last solution isn't an option her…

DNR Validity in Suicide

If a patient has a valid DNR and attempt suicide, do we resuscitate?

Nitroglycerin administration with borderline VS

Hello, I have a question regarding Nitroglycerin. Assuming they meet all indications, conditions and have no contraindications, Say I give Nitro to a Patient and there originally BP was 120/80, and I go to give a second dose, and the BP is 101/60. Sure, this Pt is normotensive now and still indicat…

Cardiac Ischemia

Seizure Medical Directive and PNES

My question is in regard to treatment expectation when faced with Psychogenic Nonepileptic Seizures(PNES). We have a "frequent flyer" in our service area that is diagnosed with PNES. Sometimes the c/c is seizure but some times it could be other things. Their seizures appear as full body posturing…

Cardiac Ischemia Treatment

Under the Cardiac Ischemia MD, is there ever a case in which it is acceptable to give ASA but not NTG (assuming conditions/contraindications are met for both)? We often see otherwise healthy patients who describe a mild to moderate, non-reproducible CP but have no features of shock, no ST changes…

Cardiac Ischemia

Methoxyflurane & Temperature

In regards to the methoxyflurane study, in the protocol itself there is no stipulation for a specific cutoff regarding an increase in temperature. At which point (what tympanic temperature) should the Penthrox be discontinued?

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