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Ep 28 Acid Base
[audio:28_AcidBase.mp3] (43:20) This week Ron did his practical testing – ET, Combitube, IV, Patient Assessment Medical and we talk about that, including answering some listener questions about testing. Ron asks Kelly, “What are vitals?” and the answer is an interesting discussion. Ron’s medical scenarios was something he hadn’t studied since Basic. He could remember what it meant and how to treat it but not the name. And he got a little creative in the treatment.
Acid/Base lecture was the last lecture Ron had and the hosts talk about how Acid/Base works.
ROME = Respiratory Opposite Metabolic Equal
Memorize the normals:
pH 7.35 – 7.45
PaCO3 35-45 mmHg
HCO3 22 – 26 mEq/mL
Remember the 3 question algorithm:
1. Is the pH acidosis or alkalosis?
2. If PaCO3 is high it is respiratory acidosis, if it is low it is respiratory alkalosis, if normal it isn’t respiratory.
3. If it isn’t respiratory from step 2, its metabolic. If HCO3 is low, it is metabolic acidosis, if HCO3 is high it is metabolic alkalosis.
If the opposite one (PaCO3 vs HCO3) is in the other direction, then it is compensated.
Mean Arterial Pressure
MAP = Diastolic Pressure + ( 1/3 Pulse Pressure )
Listener Questions
Flo sent us 3 questions related to ep 26
– Why is an accurate BP so important? It smore of a trend thing I though, and generally “is the patient normo, hypo or hypertensive.”. Does it really matter if the patient has a BP of 130/90 or ?2140/8?
– When is a pre-hospital IV indicated? Some parameds here are just plain lazy, and never do one. I had a phase where I cannulated nearly everything that moved. I know there are pros and cons in both directions, but what would you say is best practice?
– last but not least – do you have any links to the studies about paramedics leaving patients at home, that would be interesting to read up, and to present to some colleagues who really like to indulge in such practices. Always good to back up your statements with hard facts… – Flo
Also found out last night(12/9) that I will be taking the practical portion of the nation registry exam next thursday (12/16) when I come to lab. I have been watching on youtube various vids of the stations. Is there any other advise you or Kelly can give me that could help me out next thursday?? – KJ Reed
Mentions
Rogue Medic – purveyor of fine EMS research.
The Missing Protocol by Denise H Graham – out of print book.
House of God – book
Download MP3
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.
View all episodes
[audio:28_AcidBase.mp3] (43:20) This week Ron did his practical testing – ET, Combitube, IV, Patient Assessment Medical and we talk about that, including answering some listener questions about testing. Ron asks Kelly, “What are vitals?” and the answer is an interesting discussion. Ron’s medical scenarios was something he hadn’t studied since Basic. He could remember what it meant and how to treat it but not the name. And he got a little creative in the treatment.
Acid/Base lecture was the last lecture Ron had and the hosts talk about how Acid/Base works.
ROME = Respiratory Opposite Metabolic Equal
Memorize the normals:
pH 7.35 – 7.45
PaCO3 35-45 mmHg
HCO3 22 – 26 mEq/mL
Remember the 3 question algorithm:
1. Is the pH acidosis or alkalosis?
2. If PaCO3 is high it is respiratory acidosis, if it is low it is respiratory alkalosis, if normal it isn’t respiratory.
3. If it isn’t respiratory from step 2, its metabolic. If HCO3 is low, it is metabolic acidosis, if HCO3 is high it is metabolic alkalosis.
If the opposite one (PaCO3 vs HCO3) is in the other direction, then it is compensated.
Mean Arterial Pressure
MAP = Diastolic Pressure + ( 1/3 Pulse Pressure )
Listener Questions
Flo sent us 3 questions related to ep 26
– Why is an accurate BP so important? It smore of a trend thing I though, and generally “is the patient normo, hypo or hypertensive.”. Does it really matter if the patient has a BP of 130/90 or ?2140/8?
– When is a pre-hospital IV indicated? Some parameds here are just plain lazy, and never do one. I had a phase where I cannulated nearly everything that moved. I know there are pros and cons in both directions, but what would you say is best practice?
– last but not least – do you have any links to the studies about paramedics leaving patients at home, that would be interesting to read up, and to present to some colleagues who really like to indulge in such practices. Always good to back up your statements with hard facts… – Flo
Also found out last night(12/9) that I will be taking the practical portion of the nation registry exam next thursday (12/16) when I come to lab. I have been watching on youtube various vids of the stations. Is there any other advise you or Kelly can give me that could help me out next thursday?? – KJ Reed
Mentions
Rogue Medic – purveyor of fine EMS research.
The Missing Protocol by Denise H Graham – out of print book.
House of God – book
Download MP3
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.