Bypass Flashcards
consider other potentially serious conditions that may mimic a stroke, such as,
a. drug ingestion (e.g. cocaine),
b. hypoglycemia,
c. severe hypertension, hypertensive emergency, or
d. central nervous system (CNS) infection (e.g. meningitis);
assess the patient to determine if he/she has one or more of the symptoms consistent with
the onset of an acute stroke, as follows:
a. Inappropriate words or mute,
b. Slurred speech,
c. Unilateral arm weakness or drift,
d. Unilateral facial droop, or
e. Unilateral leg weakness or drift;
What is the maximum time (onset) to bring a PT to the Stroke center
6 hours of a clearly determined time of symptom onset or time the patient was last seen in
his/her usual state of health;
Stroke, assess the
patient to determine if he/she has any of the following contraindications:7
a. CTAS 1 and/or an uncorrected airway, breathing or circulation issue
b. Stroke symptoms resolved prior to paramedic arrival or assessment
c. Blood Glucose Level <3 mmol/L**
d. Seizure at the onset of symptoms or that is observed by the paramedic
e. Glasgow Coma Scale <10
f. Terminally ill or is in palliative care
g. Duration of transport to the Designated Stroke Centre will exceed two hours
if transport has been initiated to a Designated Stroke Centre and the patient’s symptoms
improve significantly or resolve during transport what should you do?
continue transport to the Designated
Stroke Centre.
In situations in which the paramedic suspects that the patient is suffering from a STEMI, the
paramedic shall:
1. assess the patient to determine if they meet all of the following indications: 7
a. ≥18 years of age;
b. experience chest pain or equivalent consistent with cardiac ischemia or myocardial
infarction;
c. the time from onset of the current episode of pain <12 hours; and
d. the 12-lead electrocardiogram (ECG) indicates an acute myocardial
infarction/STEMI, as follows:
i. At least 2 mm ST-elevation in leads V1-V3 in at least two contiguous leads;
AND/OR
ii. At least 1 mm ST-elevation in at least two other anatomically contiguous
leads; OR
iii. 12-lead ECG computer interpretation of STEMI and paramedic agrees.
Stemi, assess the patient to determine
if they have any of the following contraindications:10
a. The patient is CTAS 1 and the paramedic is unable to secure the patient’s airway or
ventilate;
b. 12-lead ECG is consistent with a Left Bundle Branch Block (LBBB), ventricular
paced rhythm, or any other STEMI imitator;
c. Transport to a hospital capable of performing percutaneous coronary intervention
(PCI) ≥60 minutes from patient contact;
d. The patient is experiencing a complication requiring primary care paramedic (PCP)
diversion, as follows:
i. Moderate to severe respiratory distress or use of continuous positive airway
pressure (CPAP);
ii. Hemodynamic instability (e.g. due to symptomatic arrhythmias or any
ventricular arrhythmia) or symptomatic SBP <90 mmHg at any point; or
iii. VSA without return of spontaneous circulation (ROSC).
e. The patient is experiencing a complication requiring ACP diversion, as follows:
i. Ventilation inadequate despite assistance;
ii. Hemodynamic instability unresponsive to advanced care paramedic (ACP)
treatment or not amenable to ACP management; or
iii. VSA without ROSC.
STEMI: What information does the PCI need ASAP
a. provide the PCI centre the following information as soon as possible:
b. that the patient is a “STEMI patient”;
c. the patient’s initials;
d. the patient’s age;
e. the patient’s sex;
f. the paramedic’s concerns regarding clinical stability;
g. infarct territory and/or findings on the qualifying ECG;
h. estimated time of arrival; and
i. catchment area of the patient pickup
which arm is prefered for a IV witha STEMI PT
• If intravenous access is indicated and established as per the Advanced Life Support
Patient Care Standards, then the left arm is the preferred site.
Field Trauma Bypass: assess the patient to determine if he/she has one or more of the following physiological
criteria
a. Patient does not follow commands,
b. Systolic blood pressure <90mmHg, or
c. Respiratory rate <10 or ≥30 breaths per minute or need for ventilatory support
(<20 in infant aged <1 year);
determine if he/she has one or more of the following anatomical criteria
a. Any penetrating injuries to head, neck, torso and extremities proximal to elbow or
knee,
b. Chest wall instability or deformity (e.g. flail chest),
c. Two or more proximal long-bone fractures,
d. Crushed, de-gloved, mangled or pulseless extremity,
e. Amputation proximal to wrist or ankle,
f. Pelvic fractures,
g. Open or depressed skull fracture, or
h. Paralysis;
Field Trauma Bypass: his/her traumatic
mechanism of injury
a. Falls
i. Adults: falls ≥6 metres (one story is equal to 3 metres)
ii. Children (age <15): falls ≥3 metres or two to three times the height of the
child
b. High Risk Auto Crash
i. Intrusion ≥0.3 metres occupant site; ≥0.5 metres any site, including the roof
ii. Ejection (partial or complete) from automobile
iii. Death in the same passenger compartment
iv. Vehicle telemetry data consistent with high risk injury (if available)
c. Pedestrian or bicyclist thrown, run over or struck with significant impact (≥30 km/hr)
by an automobile
d. Motorcycle crash ≥30 km/hr;
injury criteria listed
above, consider the following special criteria
a. Age
i. Risk of injury/death increases after age 55
ii. SBP <110 may represent shock after age 65
b. Anticoagulation and bleeding disorders
c. Burns
i. With trauma mechanism: triage to LTH
d. Pregnancy ≥20 weeks
