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BLS Patient Care Standards

Medical Directives

Dimenhydrinate in Elderly

Once Zonfran have been given to someone who is over 65 and it is not relieving the N/V after 30 mins, would it be appropriate to give 25mg of Gravol at this point even though they are over the age of 65? I understand why we do not want to give it right away. Thank you, I look forward to hearing f...

DOSE VF - Vector Change vs DSED

My question is about dual sequential defibrillation. My service was part of dose vf study which I received training on. I noticed in one of the medic news posts they mentioned paramedics who received this training are able to continue to perform VC and DSED on patients in refractory vf and vt. ...

Oxytocin administration in patients with a BP >160mmHg

Can you clarify the condition of the pt having a SBP of less than 160mmHg in order to administer Oxytocin in the post-partum / post placental delivery? My understanding is that Oxytocin reduces arterial blood pressure (through alpha adrenergic receptors & decreased in blood volume through the...

TCP for bradycardic ROSC patients

If you have a ROSC with bradycardia and hypotension that's not responding to Dopamine, at what point may TCP be considered...after Dopamine is maxed out at 20mcg/kg/min? Dopamine is increased q5 minutes.

Pediatric IV Tubing

My question is in regards to drop sets, specifically 10gtts vs 60 gtts for pediatric patients. It was my understanding that fluid administration for the pediatric pt was best done/should be done with a 60 gtts set and to not use a 10 gtts for peds. Is this an absolute rule of practice for pedia...

Transport of Traumatic Arrest in Asystole

My questions refers to the trauma cardiac arrest protocol, more specifically the trauma TOR. In the latest version of the ALS PCS (5.1), a new contraindication for a Trauma TOR is as stated "patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital <30 min transport t...

IV Initiation on Stroke Codes

When on a stroke code, does the Base Hospital want medics placing more than one IV line?

Non-Paramedics determining Obvious Death

Thrombocytopenia and Ketorolac

Why is thrombocytopenia not a contraindication for Ketorolac administration but being on a blood thinner is?

Antiarrhythmic Choice

Dexamethasone Contraindications

AIV Responsibility of Care

Ondansetron Routes for 911/Palliative Patient's

STEMI Equivalent Bypass

No Maximum # of Shocks in Cardiac Arrest

Ondansetron Route

Fentanyl for Cardiac Ischemia

Is ETT administration of salbutamol liquid appropriate?

Should SGAs be avoided in patients with esophageal disease

I have a question concerning the contraindication in the Supraglottic Airway Medical Directive. The "Known esophageal disease (varices)" do also include all the esophageal disease like example eosinophilic esophagitis, dysphagia, esophagitis, Barrett's esophagus, gastroesophageal reflux disease (...

Pediatric airway options

Given that the success rate for intubations in the pediatric populations is low, the infrequency at which these skills are performed, coupled with the stress induced by such calls I am curious what RPPEO's position is on SGA's like the i-gel specifically for the pediatric population.

Antiemetic Administration

Dexamethasone Administration for Mild Bronchoconstriction

How is dopamine used when presented as 200 mg in 5 ml rather than 200 mg in 250 ml?

14 February 2023

Dexamethasone Route

14 February 2023

IV Fluids in Cardiac Arrest

09 February 2023

Why is naloxone not recommended in cardiac arrest associated with opioid overdose?

02 February 2023

May dexamethasone labelled for IM, IV or SC administration be administered orally

31 January 2023

Is a "B52" appropriate for sedation when midazolam is ineffective?

04 January 2023

Is Epi appropriate for 55+ pt with suspected severe acute COPD with silent chest requiring BVM Ventilation & a Hx of Asthma?

15 December 2022

Should opioid analgesia be administered to a patient with opioid use disorder?

Opioid pain control for recovering addicts. What is the RPPEO stance on this? It could be severely detrimental to introduce opioids to someone currently in recovery of opioid addiction. It is not contraindicated. I often don’t bring up the possibility of opioid pain relief when presented with a ...

30 November 2022

Why is a normotensive SBP a condition for ketorolac?

Why is a normotensive SBP a condition for ketorolac? As a side note there is no SBP condition for Ibuprofen, which is also an NSAID

08 November 2022

Cardiac Arrest Patient's With Internal Defibs

03 October 2022

PCP's - How long would a patient have to be discontinued any anticoagulation therapy before considering them for NSAID treatment for pain?

Hello, I just had a patient whose blood thinners were temporarily discontinued due to an episode of hematuria. Although this patient was contraindicated for NSAIDs under our analgesia directive, it got me wondering that if we have similar patients, assuming no contraindications (as in the potenti...

29 September 2022

Analgesia on Offload

I was wondering about the ability to utilize a mix of narcotics for our patients in light of the long offload delays that we are all now facing. In discussion with my fellow ACP's there have been many of us that have called to be allowed to switch to the longer acting Morphine after beginning wit...

29 September 2022

Sodium Bicarb Administration

08 September 2022

Trauma Bypass Question - Blunt Trauma VSA with a ROSC

Why can we administer CPAP for COPD exacerbation but not for Asthma?

Recommended Management Approach for patient who is Symptomatically Bradycardic from Suspected Hyperkalemia?

What would be the recommended management approach for a patient who is symptomatically bradycardic from suspected hyperkalemia? I see a large number of potential interventions: Calcium Salbutamol Fluid Bolus Atropine Pacing Dopamine My inclination would be to treat the hyperkalemia fir...

Is CVAD considered IV access for Nitro conditions? (Scenerio)

Acute onset rapid Afid - Should the cardiac ischemia medical directive be considered for symptoms of palpitation, chest pain and similar ischemic symptoms

Do the medical directives for bradycardia require always trying TCP first before proceeding to dopamine, or is trying dopamine first reasonable?

The ECC guidelines for bradycardia show that both IV adrenergics with beta accelerating effects and TCP have equal levels of recommendation and thus, based on that, one probably isn't better than the other. Based on my limited experience with pacing, I have noted a high degree of failed or false ...

Hypoglycemia Protocol - Complete Dosage or Titrate to LOC?

Scenario Question - Severe Allergic Reaction/EPI Admin/VSA

Companion Document Cardiac Ischemia - Prior Nitro History as "previously prescribed nitro"

Patch Point to BHP - Cardiogenic Shock + Severely Bradycardic

According to our cardiogenic shock medical directive, if a patient is to be bradycardic, a BHP patch is required. In the setting of a patient in cardiogenic shock and severely bradycardic and does not respond to regular fluid therapy (STEMI found on ECG), should we be initiating treatment such as...

Patch to BHP - VSA Patient , got a ROSC then re-arrested on scene

Pad Placement - LVAD Patients

Patching for Calcium Gluconate

23 February 2022

RPPEO Standards - Renal Impairment (Ketorolac)

In respects to the Ketorolac protocol, one of the contraindications is renal impairment. What is the definition, as per the RPPEO standards, of renal impairment? Is it a known pre existing disease process of the renal system or would it also include a UTI that has manifested into a potential kidn...

Other

Other

29 November 2022

PCP or ACP - For a CTAS 1 patient who is in the back of ambulance?

Hello, In regards to a PCP and ACP working together. If we have a return CTAS 1 patient what is the direction we are being given as to who is in the back. If the PCP is comfortable being in the back and the care the patient is receiving is something within the PCP scope could they be in the back...

Could you please define the TBI contraindication for NSAID administration?

NIBP vs manual. Are medics to take a manual?

Acetaminophen for Febrile patients

23 February 2022

Transport after Administering Narcan

23 February 2022

ALS vs BLS Medic - Narcotic Administration

13 December 2021

Postpartum Hemmorrhage VSA as a Medical Arrest vs Trauma Arrest

24 November 2021

Teleflex MAD 300 and Dead space

28 October 2021

Treatment Prior to Arrival - Care and Documentation

19 October 2021

COVID considerations - Aerosol Generating Medical Procedures (AGMPs)

ALS PCS booklet availability

Pediatric Bradycardia with a Pulse

16 December 2020

Nuchal cord – manual means not working

16 December 2020

Patient Safety Plan

18 February 2020

when to put a cardiac monitor

Patient Care

20 September 2023

Just wanting to confirm if the Pedistat app is a recognized resource by the RPPEO i.e. for pt weight, ETT size/depth etc.

Joint Reduction/Manipulation

Would RPPEO consider education on joint reductions/manipulations? Under the BLS, in Extremity Injury Standard (page 125 1. f.) it states, "If adequate circulation/sensation is absent, after splinting and re-manipulation is possible, gentle re-manipulate the extremity to restore neurovascular sta...

PCP Manual Defibrillation

As a PCP in my service for Medical cardiac arrest i am required to utalize the Analyze button on our monitor instead of manual interpretation. When asking my service why they state the BH doesnt want it, when asking at BH CME's im informed my service does not want it. I am slightly confused as to...

May the Canadian C-Spine Rule be applied in patient assessment

Just a question in regards to spinal immobilization. Is it still acceptable to apply the Canadian C-spine rule? Or was that just a temporary study and we should now revert to the BLS SMR standard?

Stroke Onset Clarification

Inter-facility transfer of chest tubes

Bladder Irrigation During Transfers

Pharmacological Overdose Resources

29 December 2022

Treatment of hypotension in Sepsis

Is an RN escort needed to transport a stroke patient who has received TNK?

Pediatric Defibrillation

23 February 2022

STEMI Bypass - Scenerio (Closest ER vs Heart Institute)

23 February 2022

Inter-facility Transfers - Patient under our care or care of sending physician?

15 November 2021

STEMI after ROSC

60 minutes from 1st pt contact definition

Professionalism

Paramedic Practice

Rounding Medication Doses

When preparing medication, for example IM Midazolam for a 36kg pt, the 0.2mg/kg dose would be 7.2mg. Using a 5mg/ml concentration that would be 1.44ml volume of medication. Using a 3ml syringe, I would only be able to accurately measure 1.4ml dose. Is it acceptable to round down the dose in this...

Palliative Care Medications

With palliative care directives now becoming a core directive, what is the RPPEOs stance on using these medications for general practice. Examples include: using hydromorphone for pain management for someone who has previous hx of hydromorphone use, ondansetron IV as opposed to SL (we still are o...

PCP AIV Ondansetron Administration

Within the palliative care directive, PCP’s can only give odanestron PO/SC. Can AIV PCP’s give odanestron IV?

Pediatric Airway Equipment Dead Space

Question received from a paramedic in regards to the length of the "tree" (filter, ETCO2, tube extender) at the end of a SGA - iGel in our case - for pediatrics. Has previously been taught that this should be minimized due to tidal volume of pediatric patients and potential to be rebreathing expe...

Appropriate BP Site

14 February 2023

Intranasal Dexamethasone

31 January 2023

Postural Vital Signs

25 January 2023

STEMI + and Transport to PCI Timeline

10 November 2022

Stroke Onset & Transport to Stroke Centre