The Physics of Anesthesia

MmacFN · Apr 23, 2006

here is what is wrong with your theory

You are always able, in daily practice, to have your palm or you cheat sheets. Why would you ever want to rely on hand calculations for something so dangerous? While its nice you have learned how to do math by hand, i think its adding risk to your job and the patient.

I give meds everyday that are dangerous, do i know the calcs and the doses, sure i do. Do i consistantly check it via my palm or some cheat sheet? Absolutely, its the right thing, and the safest thing to do.

Again, its great that you can do it. However, in this day and age where 131-292 / 100000 hospital patient deaths are caused by medical errors ,drug calcs being nearly 50% of those (ref at bottom), your always better checking with a guarenteed device.

Kohn L, Corrigan J, Donaldson M, eds. To Err Is Human: Building

a Safer Health System. Washington DC: Committee on Quality of

Health Care in America, Institute of Medicine, National Academy

Press; 2000.

athomas91 · Apr 23, 2006

no mmac... here's the problem... you can't use any of those on the SEE exam or boards.... so like the previous poster said...get used to never using them.....we aren't allowed to use them on any school exams either...again another way to reinforce you do it manually.

MmacFN · Apr 23, 2006

hey thomas

Oh yes, i wasent thinking in those terms (school) i was just referring to day to day work. Your absolutely right (as is the OP), it has to be learned in school without aids. I do believe in practice, these aids are valuable tools.

no mmac... here's the problem... you can't use any of those on the SEE exam or boards.... so like the previous poster said...get used to never using them.....we aren't allowed to use them on any school exams either...again another way to reinforce you do it manually.

Pete495 · Apr 23, 2006

Part of the point also was that if those resources are not avail. then you will have to do it by hand, which I totally believe in. I don't even take my PDA to work, cuz I think it looks bad in the OR to be looking at it. I do have a calculator with me all the time, and I constantly have to keep brushing up on my math and simple equations for figuring drips out and also locals, which are a pain in the a*s to remember.

jwk · Apr 23, 2006

here is what is wrong with your theory
You are always able, in daily practice, to have your palm or you cheat sheets. Why would you ever want to rely on hand calculations for something so dangerous? While its nice you have learned how to do math by hand, i think its adding risk to your job and the patient.
I give meds everyday that are dangerous, do i know the calcs and the doses, sure i do. Do i consistantly check it via my palm or some cheat sheet? Absolutely, its the right thing, and the safest thing to do.
Again, its great that you can do it. However, in this day and age where 131-292 / 100000 hospital patient deaths are caused by medical errors ,drug calcs being nearly 50% of those (ref at bottom), your always better checking with a guarenteed device.
Kohn L, Corrigan J, Donaldson M, eds. To Err Is Human: Building
a Safer Health System. Washington DC: Committee on Quality of
Health Care in America, Institute of Medicine, National Academy
Press; 2000.

You kill me with your stats.

You better be able to do 99.9% of this stuff in your head in the OR. Your patient's condition will continue to deteriorate while you're looking things up in your PDA (hope the battery isn't dead from overuse). It all becomes 2nd nature after a while IF you don't rely on crutches. Of course I have no study to back up this opinion gleaned from 25 years in anesthesia...

rayman · Apr 24, 2006

Hey Mike. I can see your point. You have to know the formulas in your head regardless, so the calculator just facilitates the basic math? I had an old algebra teacher in jr high that was a Korean War vet with one good eye from a shrapnel wound. He told us to use our fingers or whatever we needed to get the answer. These other guys do make some excellent points, JWK especially. If you have to do it for the see, tests and boards then gotta bite the bullet. JWK is right about the crumping patient. I can remember when I first started CVICU outa nursing school and I was burning up the calculator. After a while, I could just look at the patient's weight and get pretty damn close to the right answer for a drip by just "eyeballing" it in my head. You can do it...your just used to the old crutch.:lol_hitti

rayman · Apr 24, 2006

What do you guys think of the "cheat sheets"? I appreciate your posts in regards to the pda & calculator but this seems like it might be a "good" crutch. I know all the doses have to be memorized and all but until it becomes second nature would it not be a safety valve of sorts? Just as an off the cuff example, your new in the OR at the beginning of school and it's hitting the fan and you are trying to think of the dose of neo to give but its starting to run down your pants leg instead. Would it not be a good idea to have a sheet as a backup? Whaddya think?

MmacFN · Apr 24, 2006

The evidence suggests it is much safer. Over and over studies show that people make mistake more often under pressure. That is the primary reason why AHA has changed their expectation from memorizing doses for ACLS/PALS to utilizing cards and memory aids. Even with a patient in extremis, it is better you take the second to look at your reference than give an incorrect dose or incorrect drug causing iatrogenic negative outcomes. I developed a "brain Book" for the air med people at my company as a memory aid for this very reason.

At the end of the day, however, school is school. There are no memory aids, no brain books and sometimes calculators are not allowed. You simply have to suck it up and learn it. When the time comes that you practice on your own, tools and memory aids decrease human error, until then, its all you baby

jwk · Apr 24, 2006

The evidence suggests it is much safer. Over and over studies show that people make mistake more often under pressure. That is the primary reason why AHA has changed their expectation from memorizing doses for ACLS/PALS to utilizing cards and memory aids. Even with a patient in extremis, it is better you take the second to look at your reference than give an incorrect dose or incorrect drug causing iatrogenic negative outcomes. I developed a "brain Book" for the air med people at my company as a memory aid for this very reason.
At the end of the day, however, school is school. There are no memory aids, no brain books and sometimes calculators are not allowed. You simply have to suck it up and learn it. When the time comes that you practice on your own, tools and memory aids decrease human error, until then, its all you baby

Let's remember that ACLS and PALS are most useful for people who don't manage ACLS and PALS patients very often, although obviously they're good overall guidelines. The people who DO treat this kind of stuff routinely had BETTER KNOW THEIR SH*T COLD. You think the cardiologist is going to look up the proper dosage of amiodarone? You think the surgeon is going to look up gallbladder anatomy before a lap chole? No, they know their stuff. So should you.

Obscure physiologic and pharmacologic stuff? Sure, use your PDA and (gasp) a PDR, or even a textbook (yes we do that on occasion). The point is, the stuff you do day in and day out should be 2nd nature, like tying your shoes. We are the experts in our field - we HAVE to KNOW this stuff - that's what separates US from the RN who thinks they know how much propofol to give to reduce a shoulder (sorry, couldn't resist ) or from the ER doc or paramedic who have done just a few too many unnecessary surgical airways because they don't intubate often enough. Anesthesia is (hopefully) going to be YOUR profession. LEARN IT!

MmacFN · Apr 24, 2006

well said jwk