Recent Questions

Should CPR compression be smooth or sharp and quick? (7-18-2008)

Should we use a PAD AED if it is already attached to an infant or child? (7-16-2008)

Do prescription glasses provide adequate PPE protection? (7-9-2008)

Can we give aspirin even if our patient took it only 2 hours ago? (7-7-2008)

How do US cities compare in survival from SCA? (7-7-2008)

For pts who re-arrest do we restart with analyze late or use the standard protocol? (7-1-2008)

Is dehydration a factor in hypothermia? (7-1-2008)

For a poisoning, should we call Poison Control or our medical control? (6-16-2008)

What is the definition of mental competence? (6-10-2008)

Is anyone doing field studies of troponin? (6-4-2008)

Altered Mental States

What is a Jacksonian march? (12-26-2007)

What causes syncope in a standing person with locked knees? (12-21-2007)

Can strobe lights cause a seizure? (10-11-2007)

Do all decreased LOC patients need a medic eval? (9-6-2007)

What is the significance of incontinence and blown pupils in a seizure patient? (1-31-07)

What if an altered mental status patient doesn't want to be transported? (11-2-06) 

Can a patient respond to painful stimuli and have no gag reflex? (2-28-06)

Why can't EMT's check gag reflexes any longer? (2-14-06)

Can a patient have a seizure without a postictal phase? (1-13-06)

Do we still use syrup of ipecac? (5-2-05)

Can the acne drug Accutane cause a high? (12-14-04)

Why activated charcoal vs. syrup of ipecac? (7-23-04)

Cardiovascular

Can we give aspirin even if our patient took it only 2 hours ago? (7-7-2008)

Is it possible to feel v-fib when checking a carotid pulse? (4-3-2008)

Should we give aspirin for ACS if unable to take a BP in both arms? (3-27-2008)

What does cyanosis above the nipple line indicate? (3-26-2008)

Is film-coated aspirin the same as enteric-coated aspirin? (3-10-2008)

What’s the minimum age for giving aspirin for ACS? (2-19-2008)

Can calcium chloride be given with diltiazem? (2-7-2008)

Can I give baby aspirin to a patient with acute coronary syndrome? (1-18-2008)

How high does diastolic BP need to be to have perfusion in cardiac tissue? (12-24-2007)

At what point is hypertension a medical emergency? (11-26-2007)

Why do unstable angina patients frequently have chest pain at night? (11-21-2007)

Can we give aspirin even though a patient has taken a baby aspirin? (10-8-2007)

Can an EMT offer aspirin to a patient for an acute coronary event? (7-27-2007)

Does verapamil relieve ventricular tachycardia? (7-27-2007)

How are the Seattle/King County medics cooling cardiac arrest patients? (6-26-2007)

Can stress or depression cause v-tach or bradycardia? (4-3-2007)

In transcutaneous pacing, can you up the electricity to gain mechanical capture? (3-15-2007)

Will magnetic bracelets affect a patient with a pacemaker? (2-16-07)

Does hemophilia protect against myocardial infarction? (12-20-06)

Why does chest pain radiate? (10-20-06)

Why does morphine lower blood pressure in cardiac parients? (8-30-06)

In regards to CHF, why would only one extremity show signs of edema? (4-17-06)

Has there been a change in the chest pain criteria for ALS dispatch? (12-30-05)

Can EMTs give baby aspirin for cardiac chest pain? (6-23-05)

Why can't BLS responders administer aspirin? (11-17-03)

Diabetic

How should we check gag when giving oral glucose? (4-14-2008)

When will EMTs start using glucagon? (2-21-2008)

Why is oral glucose contraindicated in altered LOC patients who cannot swallow? (11-26-2007)

How long does it take the liver to restore glucose reserves after glucogon is given? (11-20-2007)

In regards to insulin, what is a "unit"? (11-14-2007)

What happens if a non-diabetic takes insulin? (3-23-06)

Does undiagnosed diabetes present with hyperglycemia or hypoglycemia? (3-15-06)

What if a diabetic with low blood sugar refuses care? (1-31-06)

What are the new protocols for leaving a diabetic at home? (12-5-05)

Should I transport a hypoglycemic patient who's taking an oral anti-diabetic? (7-8-05)

What is the prognosis for someone with diabetic coma? (6-28-04)

Which lancets should be used for glucometry? (10-29-03)

Environmental and Burns

Is dehydration a factor in hypothermia? (7-1-2008)

What is BLS care for electrocution with no signs/symptoms of injury? (6-4-2008)

Should induced hypothermia a part of the treatment for cold-water drowning? (3-4-2008)

Can EMTs cool a burn injury and what if I encounter ointment on a burn? (1-11-2008)

Am I putting patients at risk by using latex gloves? (11-6-2007)

For hypothermia, what is the maximum "warmth" an IV fluid should be? (11-23-05)

How do you obtain a BP on hypothermic patient without a radial pulse? (10-19-05)

What are some breathing techniques for forcing acclimatization? (9-23-04)

Why use lactated Ringer's instead of normal saline in burns? (6-17-04)

Should you cool third degree burns prior to covering them or cover loosely only? (2-19-04)

Is D5 normal saline better for hypothermia? (2-18-04)

Infectious Disease

Do prescription glasses provide adequate PPE protection? (7-9-2008)

In the event of a needlestick, can the source patient refuse to be tested? (8-24-06)

What is the incubation period for scabies? (4-17-06)

Should I re-gown and glove up in the hospital room for a transfer? (7-12-05)

Is it okay for an EMT with an infectious disease to work on patients? (6-14-05)

What does it mean to test positive for TB as opposed to being contagious with it? (5-13-05)

What causes the skin to be mottled in meningitis? (2-11-05)

Should EMTs and paramedics be vaccinated for meningococcal disease? (2-1-05)

Is Hepatitis C a significant threat to EMS providers? (1-19-05)

What are the options for immunization against Hep A? (2-17-04)

Legal/Ethical

Is it legal to give someone another person’s inhaler if they really need it? (4-28-2008)

What should we do with a pt. with a potential spine injury, but refuses backboarding? (4-8-2008)

What role does a durable power of attorney have when a pt. has no POLST or DNR? (4-4-2008)

Do on-the-scene recordings violate patient privacy? (3-3-2008)

What patient information can be given to police at the scene? (10-8-2007)

What is the age of consent for medical care? (5-31-2007)

Is notifying a patient’s work manager violation of HIPPA? (3-20-2007)

Are off-duty EMTs protected by Good Samaritan Laws? (3-7-07)

Should I send a stable patient who is underage, with a minor injury, to the hospital via POV to avoid expense to his family? (1/19/07)

Can a minor be restrained for the purposes administering treatment, even if he declines? (1-12-05)

What if a patient refuses treatment? (12-5-05)

Is it okay to discuss information about a call I was on with some over the phone? (5-31-05)

Can a minor be restrained for the purposes administering treatment, even if he declines? (1-12-05)

OB/GYN

How long after birth is umbilical IV access available? (5-7-2007)

Why would an ectopic pregnancy cause syncope? (2-12-07)

Can ectopic pregnancy occur in the abdomen? (7-25-05)

What is the difference between para and grava? (11-17-03)

Operations

Are dispatchers supposed to be giving information on potential infectious disease situations? (4-4-2008)

When should BLS units respond without lights and sirens? (2-20-2008)

What is the flow of EMS authority from the physician to the street provider? (12-26-2007)

What are the guidelines for transporting a BLS patient code red? (8-10-2007)

Are Seattle/KC EMS providers required to where gloves and eye protection on all calls? (12-7-06)

What are the specifications hospitals have to meet to be considered a trauma center? (11-7-06)

Can private ambulance companies only respond code yellow unless requested by BLS/ALS units on scene to respond red? (5-8-06)

Can Pierce County medics practice in King County while on mutual aid? (4-2-06)

Can a hospital refuse a patient after they hear the report? (3-29-06)

Are there standards for nursing home care? (6-11-05)

Who is responsible for HIPPA instruction? (5-18-05)

If there are three firefighters on the scene, can they share skills? (4-29-05)

Is it OK to do a follow-up home visit for a patient? (3-10-05)

Why don't private ambulances carry pulse oximeters? (6-18-04)

How can I get follow-up clinical information on a patient without violating privacy? (12-8-03)

Orthopedic

Is a traction splint contraindicated if motor/sensory are good? (4-1-2008)

What is "delayed definitive care" as related to joint dislocations? (3-26-2008)

Patient Assessment

How can I quickly assess pulse and breathing rate? (4-1-2008)

Why don’t Seattle EMTs use glucometry? (1-28-2008)

Can I auscultate a reliable BP by placing the BP cuff on the forearm? (12-11-2007)

Why aren’t CO monitors approved in King County? (11-27-2007)

Can KC EMTs use automatic BP monitors? (11-20-2007)

While checking a patient’s BP I heard a pulse all the way down to zero. What’s going on? (7-19-2007)

Which is a more reliable BP…systolic/palp or systolic/diastolic? (6-18-2007)

What is dependent lividity? (1/6/07)

Is irregular pupil size relevant in the assessment of a conscious patient? (12/13/2006)

What is dependent lividity? (5-13-06)

What are the critical cut-offs for systolic and diastolic BPs? (3-25-06)

Which is of more concern--high systolic or high diastolic BP? (3-1-06)

Pediatrics

Is there a difference between racemic epi vs epi SVN for croup? (2-20-2008)

Why are uncuffed endotracheal tubes are used on infants? (9-25-2007)

Why are pediatric endotracheal tubes uncuffed? (1/22/07)

How important is it for infants to sleep on their backs to help avoid SIDS? (6-10-04)

At what age is it okay for infants to start sleeping on their stomachs? (6-10-04)

What is the youngest age can an EMT give an EpiPen to a child? (2-20-04)

Pharmacology

Is anyone doing field studies of troponin? (6-4-2008)

What are the contraindications for morphine? (3-24-2008)

Can epi be given to unconscious or pulseless patients? (2-7-2008)

What is the advantage of Zofran vs. phenergan for nausea? (12-24-2007)

Is cardizem contraindicated in a-fib? (12-11-2007)

What is the pediatric dosage for rectal Versed for a seizure? (11-28-2007)

What are your recommendations for a pre-hospital hyperkalemia protocol? (10-30-2007)

Why do EpiPens expire? (8-8-2007)

What’s the difference between anticoagulants and antiplatelets? (05-11-2007)

Can niacin cause an allergic reaction or overdose? (2-16-07)

If a patient takes epinephrine before arrival, do I need to request a medic evaluation? (1-22-07)

Can cold remedies cause increased ICP? (1/19/07)

Should I administer an EpiPen to someone with delayed signs of anaphylaxis? (1/8/07)

Can ibuprofen cause kidney discomfort? (12-26-06)

Is nebulized epinephrine effective for upper airway edema in anaphylaxis? (9-6-06)

Can you help clarify the protocol for Epi Pen administration? (6-22-06)

What are your thoughts regarding the use of nitrous oxide in the field/during BLS transport? (5-16-06)

Is it possible to use glucagon for treating esophageal spasms in the field? (2-28-06)

Is there any field treatment for esophageal spasms? (11-23-05)

Physiology

How long will the human body stay warm after death? (3-11-2008)

Are there complications that can arise from the combination of anorexia and anemia. (10-10-2007)

How does digestion function without a gallbladder? (3-16-06)

Can a cold room temperature slow visible signs of lividity? (2-25-05)

Why do D50 and insulin drive potassium out of the vascular space? (6-24-04)

If part of the pancreas is removed can it produce insulin and glucagon? (11-3-03)

What exactly are agonal respirations? (9-25-03)

Poisoning

For a poisoning, should we call Poison Control or our medical control? (6-16-2008)

Should we carry both syrup of ipecac and activated charcoal? (2-27-2008)

Which size container of activated charcoal should we carry? (1/8/07)

Pyschological and Behavioral

What is the definition of mental competence? (6-10-2008)

Aren’t psychiatric patients required to be observed at a hospital for a specified period of time? (1-3-2008)

What are possible causes of a panic attack? (10-23-2007)

What are the ramifications of administering epinephrine to someone with an anxiety attack? (9-21-2007)

Is there anything new regarding the use of a paper bag to treat hyperventilation syndrome? (8-21-2007)

Is it okay to leave a psych patient in court alone with his or her attorney? (4-18-2007)

Who should decide if a psych patient should be taken to Haborview Medical Center? (9-9-04)

Respiratory

Should a Combitube be used with airway burns? (2-7-2008)

Is it okay to treat someone with burns of the airway using a brochodialator? (10-30-2007)

Why is pulse oximetry contraindicated for patients younger than 5? (9-17-2007)

When will nebulizers become a BLS treatment? (9-17-2007)

Do Cheyne-Stokes respirations quickly lead to hypoxia? (7-23-2007)

Is nocturnal dyspnea a symptom of cardiac origin? (6-20-2007)

Is magnesium a bronchodilator? (5-29-2007)

Is a tracheostomy considered a patent airway? (2-12-07)

Can a Combitube be used in burns to the respiratory tract? (2-7-07)

How often can you give Racemic Epinephrine to a pediatric croup patient? (6-20-06)

What are some contraindications for use of a BVM? (1-06-06)

I'd like your opinion on an article about arguments against use of oxygen. (7-18-05)

What could be the cause of extreme lethargy in a COPD patient wearing a nonrebreathing mask at 10 L/min? (10-26-04)

What is proper treatment for someone in coumadin failure for recurrent multiple PEs? (10-12-04)

Can one hear the difference between Cheyne-Stokes respirations and agonals over the phone? (4-29-04)

How can you convert a non-rebreathing mask into a partial non-rebreather? (2-11-04)

Resuscitation/CPR

Should CPR compression be smooth or sharp and quick? (7-18-2008)

I know that increased pressure in the chest from ventilations reduces cardiac blood return, but doesn’t an ITD work by increasing pressure in the chest? (1-10-2008)

Where can I see the latest results from the ROC PRIMED ITD study? (11-20-2007)

Can a pocket facemask be used with an ITD? (11-6-2007)

For CPR purposes, can you define “onset of puberty?” (5-07-2007)

Where does Seattle/KC stand on prehospital hypothermia for cardiac arrest?  (5-2-2007)

Why 15:2 CPR for children? (3-13-2007)

Why does it seem that private physicians are not helping terminal patients by completing POLST paperwork for them? (1/22/07)

Where does Seattle/KC stand regarding the 2005 AHA CPR guidelines? (11-29-06)

Which CPR protocols should Kittitas County medics follow on Snoqualmie Pass? (10-10-06)

The new AHA guidelines don't mention abdominal thrusts on an unconscious patient. Is this the same for us in King County? (5-27-06)

Is it possible to disrupt a patient's cardiovascular function by initiating CPR when a pulse is present? (5-8-06)

After an endotracheal tube is placed, what is the compression/vent ratio? (4-27-06)

What will change in King County as a result of the new AHA CPR guidelines? (4-27-06)

Are there any special CPR techniques when the victim has pigeon chest? (4-17-06)

Who should I follow: the POLST order or a family member who says resuscitate? (3-16-06)

Is it OK to do continuous ventilations with a BVM during compressions? (2-3-06)

What if a patient checks "Resuscitate" in Box A on a verified POLST form? (9-7-04)

Is it possible to improve the quality of CPR with a mechanized device? (4-20-04)

What are the benefits of performing 90 seconds of CPR prior to analyzing with an AED? (12-3-03)

Resuscitation/Defib

Should we use a PAD AED if it is already attached to an infant or child? (7-16-2008)

How do US cities compare in survival from SCA? (7-7-2008)

For pts who re-arrest do we restart with analyze late or use the standard protocol? (7-1-2008)

What are the effects of AED use on an unborn fetus? (3-6-2008)

Can AED use affect a pacemaker? (1-22-2008)

Should we use the electrodes from a PAD AED if they are already attached? (1-10-2008)

Can a PAD AED be placed without training anyone nearby to use it? (1-3-2008)

Can an AED be used on a pregnant patient? (11-19-2007)

Can we use adult pads on a child by placing them in the anterior-posterior positions? (10-19-2007)

Does it matter if the pads are reversed on a biphasic AED? (10-10-2007)

Can we skip the “analyze rhythm” step if the rhythm is not shockable? (8-22-2007)

When should a magnet be used to turn off an ICD? (3-24-2007)

Are all new AEDs biphasic? (2-26-07)

Is there a requirement to carry spare batteries for AEDs? (2-9-07)

Can an AED be used on someone with a bypass surgery or a pacemaker? (2-2-07)

Should I attach an AED in cases of trauma? (1/9/07)

Should I do a pulse check instead of doing CPR after delivering a shock and seeing a normal rhythm? (9-15-05)

Under the new KC AED orders for "No Shock" should we interrupt 2 minutes of CPR if a "Check Pt" prompt is given? (10-12-04)

How should the green lead on a LIFEPAK defibrillator be placed? (4-12-04)

Should we continue CPR during AED charge up? (12-22-03)

Should nipple piercings be removed prior to shocking with an AED? (3-24-03)

Scope of Practice

For the ROC PRIMED study, how do we handle a verbal opt out request from a family member? (6-26-2007)

Does King County anticipate recognizing EMT-Intermediate certifications? (7-24-06)

Can EMTs transport a patient with an IV? (10-14-05)

Will EMTs ever be trained to start IVs and give epi? (10-14-05)

When will EMTs be allowed to start IVs? (4-9-04)

Is it possible to recognize wilderness EMT, EMT-I, and IV/Airway Tech programs for EMTs in remote areas? (3-23-04)

Is there chance of EMT-IV tech or EMT airway tech coming back to King County? (3-5-04)

Stroke

Should stroke patients receive aspirin? (4-28-2008)

Should I use high flow or low flow O2 for a stroke patient? (12-26-2007)

Can nitro adversely affect a stroke patient? (11-13-2007)

Why are we taught the Cincinatti Stroke Scale for stroke patients and AVPU for head injuries? (5-29-06)

Will a stroke patient on coumadin still receive thrombolytic therapies? (3-27-06)

Should a possible stroke patient be transported ALS or BLS? Why? (3-25-06)

What is happening to a person's body during a TIA? (2-23-06)

Are there some hospitals that don't give thrombolytics? (2-22-06)

Why is there a 3 hour cutoff for thrombolytic therapy for stroke? (1-23-06)

Are there contraindications to using high flow oxygen in CVA? (1-3-05)

Can the Cincinnati stroke scale help determine type of CVA? (11-19-04)

Is priority transport for all CVA patients the current King County protocol? (8-12-04)

Transport

Should we have transported this possible OD pt.? (3-24-2008)

Why do some departments transport stable patients by ambulance? (10-29-2007)

Should I transport a minor patient involved in a minor MVA, no injuries? (7-27-2007)

What is the protocol for transport when all local hospitals are on divert? (5-29-2007)

Should I transport intoxicated minors to the ER? (5-9-2007)

Beside Harborview Medical Center being our region's trauma center, are their any other specialties at our area hospitals? (8-13-06)

In transport destination questions, does the patient's wishes over-ride the FD's? (7-7-06)

What are the legal implications of transporting someone who already has been treated for their current problem? (5-26-06)

Is there a policy that would support NOT transporting a patient via private amb (BLS) when the patient is requesting amb transport? (5-18-06)

Are paramedics permitted to do interfaciity transports of ventilator dependant patients? (7-18-05)

Who should transport a DNR patient? (6-23-05)

If 3 or more hospitals go on "divert" status, do all these hospitals then have to accept patients? (1-27-05)

Can we bypass a hospital with cardiology services when transporting a cardiac patient when his physician directed him to another hospital? (11-17-04)

Trauma

When realigning a fracture, what is meant by a “delay in definitive care?” (2-4-2008)

Is it true that use of a tourniquet to control bleeding is coming back into practice? (12-12-2007)

Can the Trendelenburg position be used with c-spine injuries? (11-19-2007)

What are current KC protocols for PASG?  (5-7-2007)

What is the time limit/destination for amputation reimplantation? (4-27-2007)

Is it safe to administer promethazine to a head injury patient? (4-27-2007)

Treatment for electrical injury (4-27-2007)

Should I use a traction splint on an open femur fracture? (3-20-2007)

Why do trauma patients in shock shiver or shake? (3-19-2007)

What is treatment for someone suspended from a harness for an extended time? (3-12-07)

What is the meaning of the terms RSI and ICP? (12-26-06)

What is the proper sedative to be used for head injury patients who require RSI? (8-14-06)

In the ROC study, why are burn patients, prisoners, and pregnancy excluded? (7-12-06)

Is there a King County protocol for flutter valves? (4-18-06)

What should we do with a knocked out tooth? (3-30-06)

What is the current treatment for a flail chest? (3-16-06)

In Orthopedic Injuries Case Study 2 shouldn't the EMTs be using a BVM? (1-12-05)

Treatment/Standard of Care

When can restraints be used? (5-27-2008)

Can EMTs use nasopharyngeal airways in KC? (3-20-2008)

Is sternal IO contraindicated in cases of recent chest surgery? (1-22-2008)

Would a penetrating foreign body to the femur be a contraindication for a hare traction splint? (1-14-2008)

Why give low flow O2 for postictal, EtOH and headaches? (12-4-2007)

Can a medic from another county act as a medic during an emergency? (5-7-2007)

What if my treatment plan differs from the medics? (4-2-2007)

Why aren’t smelling salts or ammonia inhalants used? (3-19-2007)

Why aren’t we using Quikclot? (3-19-2007)

Are we still using ammonia inhalants? (1/6/07)

What is the proper way to place a nasal cannula: flares up or flares down? (5-31-06)

What do you recommend for epistaxis in an elderly patient on Coumadin? (5-8-06)

What's the best way to remove a TAZER dart? (4-10-06)

Is the Trendelenberg position contraindicated for a head injury? (3-29-06)

When will EMTs in KC be trained to use intermediate airway devices? (11-23-05)

What's the best method to stop a slow, oozing nosebleed in the field? (10-24-03)

Unusual

Why does blood in the GI tract cause vomiting? (11-6-2007)

Are there protocols for administering oral glucose rectally? (1/24/07)

Can urine break up venom? (4-6-04)