Someone Make It Click!

[MedicPrincess]

As I mentioned elsewhere we took our Acid-Base Balance/Fluid & Electrolytes test today. Scored a 92 TYVM.

What a pain in the butt! For everyone that has taken it, thats probably enough said.

So now I can Intubate (got my 2 in the OR - well actually got 3), I can start IV's, give injections, and know Acidic bad- Alkaline REALLY bad....

So someone tell me where in the real world of paramedic knowing the pH of Milk is 6.6, or giving a hypotonic solution will cause the cells to swell, or the correct lab values of K+, or knowing what a cations and which are anions will affect my treatment on scene. Where will I put everything I just lost sleep for the last 3 days over to use?

 

[Ridryder911]

Ever take care of O.D.'s , how about Dialysis patients..would like to RSI someday, you know really you are screwing up the homeostasis of the body? Do you understand why sux should not be given in patients that has a history of burns ? (yes it has something to do with all that cellular K+ stuff) Ever seen patients that are dehydrated, tachycardia... how about patients that exhibit PVC's, v-tach, v-fib without coronary occlusion?

Here you go...
http://www.emtlife.com/showthread.php?p=38436#post38436

That is part of the problem, most medics are not taught well enough to see "the whole picture"...look past the part of learning the skills....

We in EMS need to worry about cellular level a hell of lot more than placing tubes and all the "neat stuff"... any one can be taught those. I can train a monkey to intubate and start and IV .. really. It is not that big of a deal. It is the education of taking care of the patient etiology and finding the underlying causes in a rapid manner

Let's discuss the oxyhemoglobin curve and the sodium and the ATP. Wonder why CPR is now 100/min instead of the old way?.. as well as not as much emphasis on intubation?......Then we can discuss ventilator patients and critical care transports....

Remember knowledge is power... good skills just compliment it.

R/r 9111

 

[oldschoolmedic]

Have to agree with Rid on this one. Remember you are just starting out as a medic, that book will only carry you so far. I always tell students, it's not the how we do something that's important, it's the why we do it that is. Prepare now to be bitten in the *** in the future by one of these little factoids you are dismissing as irrelevant today. You have met the minimum requirements to treat people not the maximum. Good luck and may your learning curve never flatten.

 

[wolfwyndd]

That is part of the problem, most medics are not taught well enough to see "the whole picture"...look past the part of learning the skills....
R/r 9111

Ok, lemme start this by saying I'm NOT a paramedic, and (at the momment) don't have an interest in being one. That being said, I DO agree with you, but I'm not sure you can teach someone in a year or year and a 1/2 worth of classes to see the whole picture, that's something that I think you really only get through experience.

I also agree with old school medic, passing the tests for certification only make sure you meet the MINIMUM standards of care. That was one of my realizations after I passed my B certification. Now that the book work is over, the LEARNING really starts.

 

[MedicPrincess]

The big reason I am asking this is it seems most everyone I talk to about acid-base balances and electrolytes tells me that I need to "know if for the exam and then to forget all about it because I will never have to use it again."

So of course then I am wondering if we never have to worry about it again and I can just forget everything I just spent the last month stressing about, then why is it such a big dang deal?

 

[wolfwyndd]

So of course then I am wondering if we never have to worry about it again and I can just forget everything I just spent the last month stressing about, then why is it such a big dang deal?

That capital P at the end. That's the big dang deal.

 

[Ridryder911]

The ones that tell you to "forget about the acid base things" are ambulance drivers with a Paramedic patch.

Do they ever transport critical care patients, or place patients on vents... how about patients in DKA, or post cardiac arrest patients....or COPD patients that are exacerbated, CHF patients ?

The relevance of this is "it is part of medicine".. can you imagine an ER Doc describing that they will never have to know about surgical procedures since they are not surgeons ?

I believe EMS is about the only medical field that receiving an education has to be justified. What a shame..... maybe, because most never went into this field to be medical, rather for the excitement and whacker syndromes. I have never seen nursing, med school students, even lab technology, and gripe of learning basic medical foundations. If EMS was really educated in basic medicine they would realize the foundations is based upon basic science and understanding of the anatomy and physiology, and especially at the cellular level. Again, many medics (or self proclaimed) never realize many medications we administer may alter such. But, again I don't expect many to realize this as placebo Paramedics.

Can you imagine all the material I have learned in O.B., Psych, med-surg, and surgery, that I will probably never use... but, receiving such education has harmed me ? No, in fact the responses on calls, having knowledge of such has allowed me to be able to perform a better history and assessment.

For EMS to ever be respected as a true medical profession, and to gain the respect from other medical peers, they too must have an basic understanding (like every one else) of medicine. Anyone, can be taught how to perform 1'st Aid, and treat someone for the first 20 minutes.... really think about it, how hard it is to learn ..
Trauma: oxygen, repeat v.s., start IV of NSS or RL @ w.o. rate... monitor and rapid transport...splint and immobilize appropriately.

Hell, anyone can be taught this.. and this is were Paramedic programs have failed. A lot has been trained this, and it is way too easy to become a Paramedic and hard to become a great Paramedic.

We need to increase the education of Paramedics, to be actively respected as a health care professional, have a general knowledge base of basic science and medicine. Dumbing down or simplifying things is not the answer.

R/r 911

 

[Guardian]

If you don't want to learn how the body regulates pH, then you don't want to be a paramedic. This stuff is IMPORTANT. It really pains me to hear paramedic students talk like this. I've taken some hard classes like calculus based physics, organic chemistry, etc. Trust me, the paramedic curriculum is not to hard. In fact, it's insulting easy. The acid-base balance section of a paramedic book takes up 2 or 3 pages. It took me about an hour to learn it and god knows, I'm no genius. If anything, they should expand the acid-base balance section. On a side note, this is why I'm in favor of paramedic students without field experience. When someone works as an emt for a couple of years before going to paramedic, they pick up all the bad habits from their ALS providers. They also start to think they know all there is to know because they watched their ALS provider intubate and push a few drugs. So, to all the paramedic students or soon to be paramedic students, stop complaining and study. Read, don't talk. You don't know crap about crap yet. When you earn your P, you can complain all you want, but until then shut up and read. To all the paramedics who think learning the acid-base balance stuff isn't important, you're all bunch of idiots, please quit ems and apply to work at a payless shoe store.

 

[MedicPrincess]

If you don't want to learn how the body regulates pH, then you don't want to be a paramedic.

Okay Guardian, I am having probably the worst week or so that I have had in a really long, if not ever, time....so I am going to just hope and pretend you are not speaking to me directly. Because if you were, you have obviously not read a single thing I have ever posted.

That being said, I am glad for you the acid base part of your P program wasn't that hard. Yippee freakin Doo Dah. Guess what, it took me a lot of studying to make it stick. The person I studied with, made it look easy easy. Now, we will be studying drug dosages together and for him that is very hard, because guess what, he sucks a big one at math and I can to that stuff in my head. Point is just because something came easy for you doesn't give you liscense to berate someone for they are having trouble with it.

Now, the funny thing about me is, I really do want to know the Why part of what I am doing, not just the mechanical "a monkey and intubate" part. I was simply asking if, as I am being told every single day by "seasoned" medics to just forget all that Acid-Base balance and Electrolyte crap then why did we just spend almost a month of Mondays covering it.

But you know, I'm still new and really make an effort at ensure every single patient I come in contact with gets exactly what they need from me. I hear someday I'll remove my rose colored, theres gotta be a bright side, most people mean well glasses some day.

 

[Guardian]

Okay Guardian, I am having probably the worst week or so that I have had in a really long, if not ever, time....so I am going to just hope and pretend you are not speaking to me directly. Because if you were, you have obviously not read a single thing I have ever posted.

That being said, I am glad for you the acid base part of your P program wasn't that hard. Yippee freakin Doo Dah. Guess what, it took me a lot of studying to make it stick. The person I studied with, made it look easy easy. Now, we will be studying drug dosages together and for him that is very hard, because guess what, he sucks a big one at math and I can to that stuff in my head. Point is just because something came easy for you doesn't give you liscense to berate someone for they are having trouble with it.

Now, the funny thing about me is, I really do want to know the Why part of what I am doing, not just the mechanical "a monkey and intubate" part. I was simply asking if, as I am being told every single day by "seasoned" medics to just forget all that Acid-Base balance and Electrolyte crap then why did we just spend almost a month of Mondays covering it.

But you know, I'm still new and really make an effort at ensure every single patient I come in contact with gets exactly what they need from me. I hear someday I'll remove my rose colored, theres gotta be a bright side, most people mean well glasses some day.

Ok, I made some really bad assumptions here and for that, I'm sorry. Assumption 1, (since it was easy for me, it should be easy for everyone), you're right, it's wrong of me to make that assumption. Assumption 2, (everybody tells me it's not worth knowing so why do I need to know it), around here, when someone tells me this, it's never true. Usually the newer people try to validate their arguments by suggesting that everyone agrees with them when they really don't. I now see this was a bad assumption I made about you because apparently, all the "seasoned" providers really are telling you that acid-base balance really isn't important. Let me first apologize about making this assumption. Second, let me just say, your "seasoned" providers suck in my opinion and I sincerely hope you agree with me.

 

[Ridryder911]

Hang in there.. your feeling like every other Paramedic Student did.. "brain overload".

The point I believe we are making is most Paramedic students have not ever attended any other medical classes to compare with. For example some O.B. books are 1200 pages and not a section of a book. The science portion of the Paramedic curriculum is written at junior high level. Scary huh.? More scary most Paramedics cannot recall even most of that.... this says a lot of what our profession is made up of.

I do chuckle when I hear students whine and complain... yes, it can be overwhelming.... then because it maybe new. Remember, some of your basic may not had been easy either.

Now, the reason I have a burr about it being important is I not only take care of them in field, but I as well care for them in-house. It is funny as well, to see Paramedics .. "brag and assume to have great halls of knowledge and prestige, because they can intubate and establish an IV'....only to see that have not a clue of understanding oxygen gas exchange or osmolarity gradients of fluids... so basically you telling us that you know how to not what to ?


Hang in there... it will get better in time...

R/r 911

 

[ffemt8978]

I would like to say this much...

When I went through my EMT-I class, we actually spent a lot of time on acid-base balance. Our instructor (a great paramedic) insisted that it was important to know the reasons why we do what we do.

Her reasoning was this: The book and protocols can only teach you so much, and eventually you'll run into a patient that doesn't fall into those textbook criteria. If you know what's going on at the cellular level, you'll know what needs to be fixed to help your patient.

 

[Guardian]

I haven't taken any other medical courses per se, but I'm right there with you rid. I'm currently taking 4th year university level physics, so when I hear someone complain about how hard a paramedic program is, it makes me down right mad. Nonetheless, I guess we all complain at every level we're at presently. I constantly complain about undergraduate physics but I guess there is a physics PhD somewhere who would laugh at my troubles so I understand the other side too.

 

[trainSTAT]

Ever take care of O.D.'s , how about Dialysis patients..would like to RSI someday, you know really you are screwing up the homeostasis of the body? Do you understand why sux should not be given in patients that has a history of burns ? (yes it has something to do with all that cellular K+ stuff) Ever seen patients that are dehydrated, tachycardia... how about patients that exhibit PVC's, v-tach, v-fib without coronary occlusion?

Here you go...
http://www.emtlife.com/showthread.php?p=38436#post38436

That is part of the problem, most medics are not taught well enough to see "the whole picture"...look past the part of learning the skills....

We in EMS need to worry about cellular level a hell of lot more than placing tubes and all the "neat stuff"... any one can be taught those. I can train a monkey to intubate and start and IV .. really. It is not that big of a deal. It is the education of taking care of the patient etiology and finding the underlying causes in a rapid manner

Let's discuss the oxyhemoglobin curve and the sodium and the ATP. Wonder why CPR is now 100/min instead of the old way?.. as well as not as much emphasis on intubation?......Then we can discuss ventilator patients and critical care transports....

Remember knowledge is power... good skills just compliment it.

R/r 9111

Have you ever thought about contributing to online web based training as an author? Your perspective is one that I also have. It is important to know the why behind the what. My company, Trainstat.com, might make use of your knowledge/experience if you're interested.