FDNY Ride Along...

[ERDoc]

I have neither a clue what Hypotonic means, nor am I required to know what it means. It does not fall into the scheme of things, where by I would use it in the duties I am educated and/or trained to perform. I was trained to look at the IV bag, before opening it, and verify it's the correct fluid. However, I doubt it would show up in an ALS bag, unless there were to be a purchasing error. Otherwise, I have no idea what anything that you said means. None whatsoever.

And that pretty much sums up the sad, sorry state of EMS in the US.

[mobey]

I have neither a clue what Hypotonic means, nor am I required to know what it means. It does not fall into the scheme of things, where by I would use it in the duties I am educated and/or trained to perform. I was trained to look at the IV bag, before opening it, and verify it's the correct fluid. However, I doubt it would show up in an ALS bag, unless there were to be a purchasing error. Otherwise, I have no idea what anything that you said means. None whatsoever.

PLEASE tell me you do not have I.V. therapy in you're scope of practice?

[Kiwiology]

And that pretty much sums up the sad, sorry state of EMS in the US.

I agree; but what's this I hear about in US you can do a four year medical degree with between none and very little patient contact in first two years, then do a one year internship which bestows upon you an unlimited license to practice medicine then hook up to a three year vocational training program and at the end of that you're a qualified emergency medicine physician?

And here I am applying to a medical program that lasts six years, with structured patient contact and clinical decision making in all years which then requires a minimum of two years as a House Officer* only to have to endure an additional five years of specialist training but most likely six ** which makes me a Consultant Physician with a vocational scope of practice which has set limits to what procedures and medicines I can perform or prescribe*** ... man I'm such a sucker!

* PGY1 (House Officer or House Surgeon) is largely same as in the US except we do four three month rotations (runs) whereas PGY2 (Senior House Officer) can be and often is spent entirely in one speciality or only in related specialities e.g. emergency medicine or a combination of emergency medicine +/- anaesthesia +/- ICU

** five years specialist training is requires to become an emergency physician, six for dual-specialities in emergency medicine and anaesthesia or intensive care

*** the Medical Council sets a "vocational scope" for specialists which restricts the practice of specialist branches of medicine to appropriately qualified specialists (what an idea!) e.g. emergency medicine is one and is defined as "the field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders" so prescribing medicines such as adrenaline, amiodarone, insulin, potassium or haliperidol would be appropriate as would performing a thoracotomy for somebody who has a cardiac tamponade however performing a dermatology procedure or prescribing a chemotherapeutic drug would not be allowed as they do not fit within the scope of practice.

Oh and lets not get picky I know technically all antibiotics are chemotherapeutic agents but you know as well as I did we mean specific to oncology

Take that Emergentologist!

Kiwi, (MBChB, FACEM FANZCA(c. 2026))

Edited March 31, 2012 by Kiwiology

[Chief1C]

PLEASE tell me you do not have I.V. therapy in you're scope of practice?

Well, one would expect that if I did, I would know it. So... The answer is negative. I could Google every term, and pretend I know everything. But, alas, I'm human and I don't.

And that pretty much sums up the sad, sorry state of EMS in the US.

Ouch, that's rude. If I were a paramedic, et al; I'd say that were true. However, I've gone 13+ years, and never needed to know that. I've never had a complaint, never been warned or disciplined, and never failed an exam. I fail to see how my comment casts a negative light on the entire US EMS System.

[Eydawn]

1 C (will you quit changing your darn name?!)- the reason it sums up the sad sorry state of EMS is that it's really basic science that is pretty important to medicine, and yet, someone can practice in the field for 13 years with no desire to learn it (or need to). Basically, it's part of what holds us back as band-aid totin' psuedo-professional public safety kludge-type figures.

A good EMS system would require even an entry level practitioner (IV cert or no) to understand tonicity as it pertains to fluid shifts at the very least... hell, how many of our patient problems are caused by fluid in the wrong place, too much fluid in the right place, not enough fluid in the right place, etc?

Hypertension

Hypovolemia

Pulmonary edema

CHF

Systemic edema

Dehydration

Fluid volume deficit

Just to name a few... and ALL of these would be affected by a provider giving or not realizing they needed to give a solution with a particular tonicity (amount and type o' stuff dissolved within)...

Just saying.

Wendy

CO EMT-B

[Chief1C]

It's my radio identifier. One. and my name.. C.. 1 C.

Wow, judge, jury and executioner.. No desire to learn. The little bottle that I put things in, within myself, the metaphorical bottle, has been begging to be emptied in the past mehhh eight days or so. You're just going to have to give me the benefit of the doubt, If I seem callous in my replies. I may mean one thing, but type something else. That's not an excuse, it's just a personal observation. So, until I either curl up in a ball and cry; or have a small stroke. I'll try to refrain from posting anything.

[Kiwiology]

I'm on my phone posting this from the emergency department where there are two, house surgeons, a registrar and a gaggle of nurses on duty plus a couple.students and the ambos drop in once in a while to drop people off

Now certainly all three of the medical officers can tell you what hypotonic means, the nurses should be able to and the Paramedic ambos and above as well I know for a fact they all leant it

Our enry level Technicians do not learn it as part of the Diploma but they learn the general principal of fluid homeostasis as they pertain to eg pulmonary edema

Should they know hypotonic from hypertonic, active transport from facilitated diffusion and collloid osmotic pressure from capillary hydrostatic pressure yes but is it reasonable to tech the vollies that, I hate to admit it but no its not

[DFIB]

I'm on my phone posting this from the emergency department where there are two, house surgeons, a registrar and a gaggle of nurses on duty plus a couple.students and the ambos drop in once in a while to drop people off

Now certainly all three of the medical officers can tell you what hypotonic means, the nurses should be able to and the Paramedic ambos and above as well I know for a fact they all leant it

Our enry level Technicians do not learn it as part of the Diploma but they learn the general principal of fluid homeostasis as they pertain to eg pulmonary edema

Should they know hypotonic from hypertonic, active transport from facilitated diffusion and collloid osmotic pressure from capillary hydrostatic pressure yes but is it reasonable to tech the vollies that, I hate to admit it but no its not

I guess he could have googled it if he really wanted to know.

[Kiwiology]

I guess he could have googled it if he really wanted to know.

Well true

[Aussieaid]

Infusing bags of Sterile water for injection can absolutely cause serious harm!!

Infusing sterile water causes hemolysis and can lead to Acute Renal Failure. (Water will enter red blood cells across a diffusion gradient and cause the cells to swell and burst).

If you infuse too much too rapidly you can also cause hyponatremia which can cause seizures, coma and death (think water intoxication).

The bags of sterile water for injection are for pharmacy purposes only to dilute some drugs (and is given in small quantities and not infused rapidly).

If they want to treat hypernatremia in the hospitals they use hypotonic solutions such as water mixed with 4 or 5% dextrose or hypotonic saline (e.g. 0.45% saline) solutions.

Any solutions that are going to be infused directly into a patient's vein need to be treated like any drug and double checked. That is why IV fluids are "ordered" by physicians whether it is in a hospital or by standing orders or policies under a medical director.

Edited for additional: Osmolality of sterile water for injection - 0 mOsmol/L compared to Normal Saline (0.9%) - 308 mOsmol/L or Dextrose 5% - 253 mOsmol/L. Human plasma is 285-310 mOsmol/L.

Edited March 31, 2012 by Aussieaid