Download In past medical directives varied between Base Hospital Programs

Advanced & Primary Care
Paramedic
Changes to Medical
Directives
Fall 2005
“The Power of 7”
Base Hospital Programs
Cambridge
 Grey Bruce
 Hamilton
 Lambton
 London
 Niagara
 Windsor

South
West
Education
Committee
History ??
In past medical directives varied
between Base Hospital Programs.
 This year, implementation of
standardized protocols approved by
the Provincial Medical Advisory
Committee (MAC) have been released
for all Base Hospitals to follow.

“New Look”
General changes include
An introduction which clearly outlines
guidelines for:
Use of the protocols and patching to
the Base Hospital Physicians
Consent to treatment and capacity
assessment
Refusal of treatment
Cardiac monitoring and oxygen
administration
“New Look”
Adult and Pediatric protocols are not
combined – but will be in the future.
Auxiliary Protocols.
Personal Protective Equipment use for
paramedics is clearly outlined within the
appropriate directive, specifically
nebulized medication administration.
SOB/Respiratory Distress
Protocol
The new medical directives indicates
that salbutamol administration will not
exceed 3 doses…
previously…maximum administration
was 2 doses
SOB/Respiratory Distress
Protocol
Contraindications for nebulization of
salbutamol now include:
Patient has a suspected or known fever
(> 38.0 C)
OR
In the case of a declared outbreak of a
severe respiratory illness by the local
Medical Officer of Health
SOB/Respiratory Distress
Protocol
Procedure changes:
Salbutamol should be administered via MDI if
available
If MDI not available or the patient not able to
use the MDI/spacer properly then administer
salbutamol via nebulizer
SOB/Respiratory Distress
Protocol
Procedure changes:
Salbutamol via spacer dose
Patients <30 kg = total of 6 puffs
Patients > 30 kg = total of 9 puffs
Salbutamol via nebulizer
Patients < 30kg = 2.5 mg
Patients > 30 kg = 5.0 mg
No longer 1.25 mg for pediatric patients
Moderate to Severe Asthma
Exacerbation Protocol
This protocol can now be applied to patients
where nebulized salbutamol is contraindicated
and MDI/spacer is unavailable.
Indications for application of this protocol has
been expanded to include patient presentation
of severe agitation, confusion, and cyanosis.
Moderate to Severe Asthma
Exacerbation Protocol
Epinephrine can be administered either
subcutaneously OR intramuscularly
Moderate to Severe Asthma
Exacerbation Protocol
Procedure changes:
Caution!!!
 A BHP patch must be attempted prior to
a second dose of epinephrine for
patients that are < 10 kg or patients with
a history of ischemic heart disease.
Anaphylaxis/Allergic Reaction
Protocol
Epinephrine can be administered either
subcutaneously OR intramuscularly
Caution!!!
A BHP patch must be attempted prior to a second
dose of epinephrine for patients that are
< 10 kg or patients with a history of ischemic heart
disease.
Epipen standing orders are now included for
Ambulance Services that utilize them!
Suspected Cardiac Ischemia
Chest Pain Protocol
Contraindications for nitroglycerin
administration:
Prescription medication for erectile
dysfunction within the last 48 hours
Suspected Cardiac Ischemia
Chest Pain Protocol
ASA can now be administered to
patients even if chest pain has
resolved on paramedic arrival
Acute Cardiogenic
Pulmonary Edema Protocol
Contraindications for nitroglycerin administration:
Prescription medication for erectile
dysfunction within the last 48 hours
Altered LOC- Suspected
Hypoglycemia Protocol
Glucagon now can be administered either
subcutaneously OR intramuscularly
Blood glucose tests can be done when:
a glucose problem is suspected; either
hypoglycemic or hyperglycemic
The patient can receive oral glucose if signs and
symptoms consistent with hypoglycemia are
present
Altered LOC- Suspected
Hypoglycemia Protocol
Caution! patients that are on oral
hypoglycemics are at a high risk for
recurrent episodes of hypoglycemia
Hypotension
Changes to hypotension require the
paramedic to only fluid bolus a
hypotensive patient when a known or
suspected causes exists.
IO infusions
The age for IO insertion has been
increased to 12 years.
Lasix
Not part of any standing order for CHF
but drug may be used in consultation
with a BHP during a patch for
management of a severe CHF patient.
Lidocaine
Lidocaine for intubation to prevent the
spike in ICP requires………
Arrest Protocols
Cardiac Arrest General Protocol
Paramedics, where available, should
select the lowest energy
level available for each shock for patients
between the ages of
8 and 12 years.
The End
Questions?