BC EMR -> Alberta ACP Licensing

bcemr

bcemr

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Hey everyone. I am heading to Edmonton to write the EMR license in November. I haven't sent in my application yet because I wanted to clarify something:

I am obviously out of province and don't want to be driving back and forth between Edmonton and Vancouver Island a lot. Are the written and practical on the same weekend? I am unsure if ACP is like the BC ministry and don't take phone calls, so I don't want to call and "bug" them :rofl:

Thanks folks.
 
Voodoo1

Voodoo1

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Hi there. ACP will do it in one weekend. I couldn't say for sure if you would do them on the Friday/Saturday or Friday/Sunday, but it will be done in one weekend. The Coast Plaza East gives nice discounts for students doing the exams.
 
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bcemr

bcemr

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Thanks! One final question - I am trying to find medical protocols and practical exam prep but there isn't a whole lot out there. I heard in Alberta we can't administer Nitro and must assist with Epi. This is obviously different than BC.

But I can't seem to find clear cut info on Alberta protocols online despite trying a lot of different search terms.

Cheers
 
hippocratical

hippocratical

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Here's your exciting 'drugs' an EMR can give in Alberta. Let's see if I can remember this verbatim...

The 10 things I personally do in the "Specialized Assessment - Medical" part is:

1) Verbalize ALL Indications and no Contraindications of the med you wanna give.
2) Verbalize if Pt has taken any of this med already (irrelevant really - you're still going to give it)
3) CCCE (color, clarity, concentration, Expiry date - plus that it's checked three times by you and once by your partner)
4) verbalized 6 rights of medication
5) partner gets full set of vitals
6) you tell Pt all of the possible side effects (yay all nine for Epi)
7) confirm if this is an online or offline med, and call Medical control if it is online
8) prepare and give med (verbalizing dose and route)
9) ensure documentation will get done
10) vitals taken within 5 mins of med being given

The drugs themselves (and I cant be bothered to list indications/contras/side effects - you should know these all)

Epi:
Autoinjector only
0.3mg adult 0.15mg junior
ONLINE (during scenario you MUST say that you're calling medical control to get permission)
*MUST be the patients Px (their pen)
*MUST be valid (CCCE, Px, etc)
Lateral aspect of thigh, 90°, hold 10 secs, put in sharps container
*Make sure you get vitals within 5 mins, including Auscultating bilaterally

For the rest always give the lowest dose:

Salbutamol
adult 6-20 sprays of MDI, 100mcg/spray
child 2-10 sprays
ONLINE
Same *s as above
Verbalize how it's given

Ipratropium Bromide
adult 4-10 sprays of MDI, 20mcg/spray
child 2-4 sprays
ONLINE
Same *s as above
Verbalize how it's given

ASA
160-325mg
OFFLINE
Same *s as above except the auscultating
Verbalize that it must be chewed and swallowed

Oral Glucose
25g tube of gel
OFFLINE
Same *s as above except the auscultating
Verbalize that it must be swallowed (no buccally here)

Nitro
NOT ALLOWED
but you'll still need to know all the details for your written exam.

Good times.
 
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bcemr

bcemr

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Thank you hippocratical.
Looks like I have some studying to do. I better go pick up a book, this is quite different than the training I just did at JIBC.
 
hippocratical

hippocratical

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bcemr said:
Thank you hippocratical.
Looks like I have some studying to do. I better go pick up a book, this is quite different than the training I just did at JIBC.
Click to expand...

Don't fret too much - a lot depends on which school you study at too, and then how feisty the examiner is. I was taught at a school that probably over prepares you for the exams, whilst there are other institutions that send their students out with only a very base level of knowledge.

I've always thought it's better to be over prepared than just scraping by.
 
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bcemr

bcemr

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I agree on preparation which is why I really want to nail home everything before I go. I'm a little nervous because I can't find the protocols in entirety. Your outline helped, but "online" "offline" (unsure what those are... guessing from reading into it than online means we have to call EMS [medical control] for guidance, and offline means we can dose ourselves?) and dosage amounts are different - we also can give Nitro here. Our Ventolin and Atrovent we only can administer 2 puffs (10 second hold). Our glucogel is buccal... etc.

I guess if those are the only differences I could probably re-wire my brain and manage it.

By the way - if we can't give Nitro in AB what do we do with cardiac / angina patients? Just give entonox and hope for the best?
 
hippocratical

hippocratical

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bcemr said:
online means we have to call EMS [medical control] for guidance, and offline means we can dose ourselves?
Click to expand...

Bingo. In a scenario you just need to verbalize "This is an offline drug so I dont have to call / This is an online drug so I have to call medical control..."

bcemr said:
By the way - if we can't give Nitro in AB what do we do with cardiac / angina patients? Just give entonox and hope for the best?
Click to expand...

Entonox not in Albertan EMR scope of practice. O2 only ;)
1) Give O2 + ASA + diesel (transport)
2) prepare for CPR
3) Ask to borrow some money from them

Yay advanced first aid! :p
 
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bcemr

bcemr

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Thanks guys.
I did go through the AOCP but unfortunately it just references things we should know. That's well and good, but there's no specifics. For example: Glucose orally. That's fine - but how much and how many doses? AOCP doesn't define that. So that's where I am struggling a little.

Also for ASA, how much? In BC it's 2 81mg tabs - chew and swallow. (bleeding, allergy, dose, swallow chew [BADS]) is the contra.

I'm trying to find a definitive resource and striking out so far. This has been an immense help and I suppose I could just ask here but I don't want to waste your guys' time or bug you if there is a resource or manual I can buy and just learn it that way.

PS. No nox? So we're just meat packagers then! LOL
 
L

Lacifer

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If you still need to know ACP scheduling it's Friday written and Saturday practical. They also have a retest on Sunday if you fail your first practical exam.

For oral glucose I was told half a tube. ASA is 2 81 mg tabs as well.
The whole no nitro thing here is a pain! We learned all through our EMR course that we could give it and then on the last day our instructor told us we couldn't.

Good luck on ACP!
 
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bcemr

bcemr

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Thanks. I contacted ACP they just told me to read the AOCP which is FINE... but it doesn't define exacts. I suppose I will go off of your information as well as hippocratical's detailed list and hope for the best. I just wish there was some data I could get off of someone (training sheets + protocols etc) in AB, because I have to fly to edmonton, pay for hotel and take the course so my cost will be like 1,400 so I'd hate to fail.
 
hippocratical

hippocratical

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You could contact a school in Alberta and ask for the info, but I strongly doubt that would work :rolleyes:

You could get someone who has taken a course here to show there notes, but that wont be me, as I would get royally spanked for doing that.

You can ask questions though, for information is, like, free man :p

Bear in mind though that you cant believe anything on the internet and there's a fair chance I could be lying...

house-lies.jpg
 
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bcemr

bcemr

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Okay let me give this a try and see if I can structure everything correctly and get everything in one go. :wacko:

1. Is it definitively 162mg total ASA? What if they have dosed themselves earlier? (in BC if they have we have to know how much, and depending on the answer we may or may not give them more, but hippocratical's earlier info says we dose anyway)
2. How much time passes between the ventolin and atrovent (Salbutamol/Ipratropium Bromide) doses? For example the adult guideline says 6-20 sprays 100mcg/spray. Are those all at once, if not how much time passes between dosing?
3. Do you give all 20 sprays of ventolin if they need it THEN move to atrovent? What is the general protocol for these drugs?
4. During RTC / non-rtc are the vitals every 5/15?
5. At what point do we give glucose? Ours is < 4.0 bgl, but I think I read somewhere it's 3.8 in Alberta. Is that correct?
5b. Do we take BGL on every set of baseline vitals even if the Pt is non hypo/hyperglycemic?

I think if I get those questions answers I could go into a practical test feeling pretty good.
I appreciate this a TON so thank you.
 
hippocratical

hippocratical

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Okay, bear in mind that the following is for SCENARIOLAND only. A place distantly moved from real life. With Unicorns and rainbows.

Also, this is what I was taught and others may feel that the info is incorrect. Who knows. My instructors said they never lie :rolleyes:

1. Is it definitively 162mg total ASA?
Yes*

What if they have dosed themselves earlier?
In Scenarioland they wont have. Real world - 160mg is a minute amount really. I was taught to give the lowest dose of the range. You need to know the dose range for the written exam, but for the practical it's the lowest dose. You wont need to re-dose as they should miraculously get better or suddenly keel over and need CPR. That would suck as you need CPR sequencing dialed or its a free ticket to Failtown.

2. How much time passes between the ventolin and atrovent (Salbutamol/Ipratropium Bromide) doses?
Scenarioland? See above - they will miraculously get better unless the examiner hates you for some reason. Do not annoy the examiner.

For example the adult guideline says 6-20 sprays 100mcg/spray. Are those all at once, if not how much time passes between dosing?
Scenarioland? Just say that you would give 6 sprays. Done. Wipe hands on pants. I believe in real life you'd chain them fairly close together.

3. Do you give all 20 sprays of ventolin if they need it THEN move to atrovent?

The patient has what the patient has (make sure you say you're bringing along the pt.s personal effects including medications before you leave scene!). I've not heard of a Pt in Scenarioland having both, but I've not heard of all the permutations of the scenarios they have. But I was told that in the unlikely event of a pt having both, then yes Ventolin goes first as it bronchodilates, while Atrovent helps maintain the opening of the airway etc, but would suck to be you as you'd have to give all the spiel about Side effects/indications/contras/etc for each drug. This seems so unlikely as it would take ages and the examiner wants to get out of there as much as you do.

Also, if they had both meds as prescriptions, it'd be 6 sprays of Ventolin, then 4 sprays of Atrovent. Aint gonna happen.

I have heard of a Scenario where the Pt is asthmatic, having an attack, but forgot their inhaler. Fortunately their friend is there and offers their one. Sneaky buggers - you do that and it's insta-fail! It must be the pt's meds ^_^

4. During RTC / non-rtc are the vitals every 5/15?
If it's a critical patient (which it most likely will be, as they're more interesting) then it's every 5 mins. Allegedly there are some stay 'n' stabilize pt scenarios but I've not met anyone who's had that. Allegedly there is/maybe one childbirth scenario in there. Sucks to be that guy.

5. At what point do we give glucose? Ours is < 4.0 bgl, but I think I read somewhere it's 3.8 in Alberta. Is that correct?

Alberta protocols say normal is 3.8 - 7.0 mmol. My midterm was a pt with a BGL of 2.0 so it was pretty obvious. I believe that they have to be a confirmed diabetic with a abnormally low BGL to qualify for Glucose. A regular dude with low BGL doesn't count. I think it would be paranoid to expect a scenario where they have: No Hx of Diabetes, BGL 3.6 etc.

5b. Do we take BGL on every set of baseline vitals even if the Pt is non hypo/hyperglycemic?

My school taught us to. Scenarioland =/ real life

*According to what I was taught

Hope this helps! I feel confident in the above info, but I'm not an examiner and I had plenty of, er, discussions with Instructors about conflicting sources of information. Screw it, just dont miss anything huge like applying a C-Collar and you'll be fine. Probably :p
 
hippocratical

hippocratical

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well that's 730 pages of fun right there ^_^

Interesting to see all the paramedic protocols in there too, so you see the whole spectrum of care.

What I really like though is how there are the usual mistakes in the document. Here's one I found because the protocols for Adult/Pediatric CPR drive me crazy - no one ever EVER agrees on the protocol, or at least writes it correctly.

pg. 434 -> Pediatric CPR should be 5 cycles at (pg 435) 15:2
pg 435 -> 5 cycles will take approx 2 minutes

Good grief! 15:2 is half of 30:2. If 5 cycles of adult 30:2 takes 2 minutes then 5 cycles of ped 15:2 will take less time (half).

I have been taught by several instructors, and read in a variety of places all of the following regarding kid CPR:

1. 30:2 for 5 cycles (2 minutes ish)
2. 15:2 for 5 cycles (1 minute ish)
3. 15:2 for 10 cycles (2 minutes ish)

Up to reading this protocol I was banking on number 3. making the most sense.

So if instructors/protocols cant agree, there's a fair chance that the examiners (who are instructors probably) also have different ideas as to what is "correct".

Yay exams!
 
Nervegas

Nervegas

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You guys give Ventolin and Atrovent via inhaler? Is it the Pt's prescription?
 
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