Alberta EMR Protocol

pumpkin

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Hi everybody,

I recently took the EMR course in BC and am now studing for the licensing exam in Alberta. The protocols are slightly different and I would greatly appreciate some clearification because this is confusing the hell out of me.


1) Basically, for cardiac chest pain, SOB and anaphylaxis, when do you intiate load and transport??
After the primary survey (and secondary assesment and treatment in the ambulance) OR after completing the secondary survey on scene and assisting with meds do you then transport them?

2) After history and vitals it states "physical examination findings" does this mean you have to perform a head to toe before administering medication?

3) Do you test BGL for all patients experiencing altered level of consciousness or only those with a history of diabeties??

Answers to any of these questions would be awesome, thanks in advance!!
 

saskvolunteer

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This sounds more like where an individual's assessment leads him/her than an ACoP protocol/regulation.

You should be making your determinations on what to do next as you proceed through your assessment of the patient. If following the primary assessment you realize the patient is in a time critical condition, then load and go. But you can't rely on random people on the internet to answer this question. Furthermore, I'd imagine company protocols would have some pretty good hints regarding this.

You'd probably be better off posing this question to ACoP.
 

mediKate

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Hey, good luck on your exam! When do you write ACP?
Good questions! Here's my best shot...

1)In an ACP EMR scenario, you pretty much without exception do your primary on scene, then state that pt. is a load-n-go, package, and do the rest of your scenario "in the back of the ambulance". They want to see you administer all drugs (with the exception of 02, of course), and most interventions, en route. So initiate transport as soon as you are done your primary survey.

2) Not quite sure what you are referring to there - is this during your primary or secondary? Your primary survey (with a complete head-to-toe) should be completed before administering any medication.

3) Run a BGL on EVERY pt., regardless. But especially on any that are altered or suspected hypo/hyperglycemics.

So you're basically going to do a 1) initial assessment, 2) ABCs LOCs, 3) primary, 4) package and transport, then 5) vitals, history, and SAMPLE OPQRST. Only after that do you administer meds, splint, bandage, etc.

Hope that helps. Good luck on your exam! :cool:
 

Voodoo1

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Everything that MediKate said and know your meds inside and out. Indications, contraindications, side effects all that good stuff. And know which meds are online or offline. When do you write?
 

hippocratical

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I too second MediKate on the answers.

Most schools round here will give out a list of steps for the practical, but they can be very cagey about handing it out to non students.

Best bet is to become a machine at the practical exam too. I practiced repeatedly for literally months (stupid only 5 ACP exams per year!) with my patient Big Fat Bob (clothes stuffed with plastic).

The worst thing about the ACP is that you have to not only visit, but also stay in Edmonton for the exam. Bleurgh!

:p
 
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pumpkin

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Thanks so much for the prompt answers!! It helps alot!! I write the exam on Friday and Saturday.
Just to clearify question 2... I know to do a rapid body survey in the primary survey, but it states on the flow chart for hypogycemia "physical exmination findings" ie confusion, agitation and altered LOC... if yes: then take and record BGL reading, if not: transport.

Which order is correct?:

history -> vitals -> head to toe -> adminster glucose (if less than 3.8) OR
history-> vitals -> administer glucose -> head to toe

Also, is getting a temperture reading part your vitals?? If so, I just stick the termaitor in their mouth?

Thanks again!!
 

adamjh3

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Oh and I forgot to ask what are online and offline medications??

Stab in the dark, online likely needs a base hospital order while offline will be a standing order. Someone slap me if I'm wrong

Sent from my DROIDX using Tapatalk
 

mediKate

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Okay, so you have done your primary head to toe, and identified a problem. You are in the back of the unit, en route, and your order now is going to go:
1) history,
2) vitals (I usually do vitals first, then history, but whatever floats your boat.)
3) med. assist/interventions
4) secondary survey/head-to-toe

Yeah, go ahead and do temp. in your vitals. You might catch something you would otherwise have missed. Do the whole kit and kaboodle. SPO2, BGL, RR, pulse, BP, temp, ETCO2, everything. On everybody. You can't go wrong.

Let us know how you do, eh? :)
 

mediKate

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Stab in the dark, online likely needs a base hospital order while offline will be a standing order. Someone slap me if I'm wrong

Sent from my DROIDX using Tapatalk

*SLAP*
No, I'm kidding! I honestly am not sure either. But it must be something to that effect.
All I know about is online and offline protocols. Offline being standing orders, and online being where you phone medical control and go "uhhh... "

From what I remember *looks over ancient EMR textbook* EMRs can just administer O2, ASA, Epi, Glucose, Ventolin, and Atrovent. Right? :unsure:
I am pretty sure (but not willing to be slapped over it ;) ) that you wouldn't be able to administer anything else, even under a doc's orders, . Not as an EMR anyways.
 

Voodoo1

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Oh and I forgot to ask what are online and offline medications??

Offline medications are ones that you do not have to call medical control for permission to administer. So ASA and Oral Glucose
Online medications are meds that you DO have to call medical control for permission to administer. Atrovent, Ventolin, and Epi.
At the EMR level, we can't assist with Nitro, but you need to know the indications, contraindications and side effects.
See you on the weekend!

Ps: Let me know if you need some help studying. I'll do my best to help you out.
 
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Voodoo1

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pumpkin

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Thanks again for your replies!!

This brings me to another question:

Why do you have to call Medical control before helping administer Epi, Atrovent and Ventoline?? Don't they have a history, of either asthma or anaphlaxlis, therefore a perscription and their own meds.

Also, I was told that you only help them take their Atrovent if they would be normally taking it at that time, is this the case in Alberta??

The differences between the two provinces are driving me insane :wacko:
 

Voodoo1

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Thanks again for your replies!!

This brings me to another question:

Why do you have to call Medical control before helping administer Epi, Atrovent and Ventoline?? Don't they have a history, of either asthma or anaphlaxlis, therefore a perscription and their own meds.

I would love to give you a stellar answer to this question, but I don't have one, so I am going to ask somebody who does and I will get back to you on that.

Also, I was told that you only help them take their Atrovent if they would be normally taking it at that time, is this the case in Alberta??

The differences between the two provinces are driving me insane :wacko:

I think you are right, that is the case here as well.
 
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systemet

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Thanks again for your replies!!

This brings me to another question:

Why do you have to call Medical control before helping administer Epi, Atrovent and Ventoline?? Don't they have a history, of either asthma or anaphlaxlis, therefore a perscription and their own meds.

Also, I was told that you only help them take their Atrovent if they would be normally taking it at that time, is this the case in Alberta??

The differences between the two provinces are driving me insane :wacko:

"ventolin", "anaphylaxis", "prescription".

The requirement to contact medical control before administering these medicatons is probably there because the EMR level has a minimal amount of training. Medication administration at this level is relatively new.

There are dangers with these medications, and there's a concern that EMRs may not always be able to identify dangerous situations.
 
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pumpkin

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Hey everybody,

Just to let you know I passed the pratical!!! (on the second try!!)
Stuck waiting 4-6 weeks for the witten, but I'm feeling confident.
Well that was the most stressful/expensive weekend of my life :)
 

systemet

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Hey everybody,

Just to let you know I passed the pratical!!! (on the second try!!)
Stuck waiting 4-6 weeks for the witten, but I'm feeling confident.
Well that was the most stressful/expensive weekend of my life :)

Congratulations! Good luck!
 

mediKate

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Lol!! I know the feeling!

Way to go! :)
 
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