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Here’s a tricky one to remember but an absolute must-understand for any Paramedic and EMT with IV certs.

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IV fluids aren’t just water. They have stuff mixed in at variable ratios. Once fluids are inside the body, the body will begin shifting the solutes (stuff) and solvents (fluid the stuff is mixed in) to achieve homeostasis. This is typically done by osmosis. The tonicity of a fluid will determine how fluids are shifted between the extracellular and intracellular spaces.

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To start, cells want to be in an isotonic state, which means equal on both sides. In this case, they want to have equal solutes/solvents on the outside as they do on the inside. So Let’s discuss the tonicity of commonly administered fluids.

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Isotonic fluids - these are fluids that have the same concentrations of solutes/solvents as inside the cells. Because things are equal, the body doesn’t need to shift anything.

▪️This means that (I)sotonic fluids stay where (I) put them. This keeps cells the same.

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Hypertonic fluids - hypertonic fluids are high in solutes and low in solvents. Because the body wants to find an equilibrium, the body needs to further dilute the solutes inside the vessels and extracellular spaces. It does this by shifting fluid OUT OF the cells.

▪️Hyp(e)rtonic solutions cause fluid to (e)nter the vessels and extracellular space. This causes cells to shrink.

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Hypotonic fluids - hypotonic fluids are low in solutes and high in solvents. Because the body wants to find an equilibrium, the body needs to do something about the extra fluid inside the vessels and extracellular spaces. It does this by shifting fluid from the vessels and extracellular spaces INTO the cells. ▪️Hyp(o)tonic solutions cause fluid to go (o)ut of the vessels and extracellular space and into the cells. This causes cells to swell.

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This may or may not have made understanding the tonicity of fluids any easier. It may be easier to discuss this in a video. If so, would you like a video? Let us know in the comments!

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Repost from Gold Standard EMS:

When we’re talking about acid-base balance what we’re really talking about is pH. pH measures the acidity of a solution, in this case it’s blood. The scale ranges from 0-14. 0 being acidic and 14 being alkaline. The body likes to find homeostasis between 7.35 and 7.45. Movement of 0.5 in either direction is not conducive to life.

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Before we start taking corrective action, we must first define the cause of the acidosis or alkalosis so we know how to correct it. To do this, we need three measurements; pH, bicarbonate levels (HCO3), and carbon dioxide levels (CO2).

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The first thing we need to do is determine whether the patient is Acidodic or alkalotic. Given the normal range of 7.35-7.45, anything less than 7.35 is acidotic and anything greater than 7.45 is alkalotic.

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Once that has been determined, we now must figure out whether the cause is respiratory in nature or metabolic in nature. To do this, we need to figure out which set of values are within normal limits.

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Normal limits are as follows; pH - 7.35-7.45, HCO3 - 22-26mEq/L, CO2 - 35-45mmHG

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If your bicarbonate levels are NORMAL (HCO3) and your CO2 are ABNORMAL, carbon dioxide is your problem. Your respiratory system is what expels CO2 as you breathe. Therefor, your acidosis/alkalosis is respiratory in nature. To correct this, you are going to increase ventilations to either blow off the excess CO2 (acidosis) or slow down respirations to allow the low CO2 to build back up to normal limits (alkalosis).

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If your HCO3 levels are ABNORMAL and your CO2 levels are NORMAL, bicarbonate is your issue and your acidosis/alkalosis is metabolic in nature. To correct this, you are going to administer sodium bicarbonate to bring low HCO3 levels back up (acidosis) and you are simply going to keep them alive until the excessive bicarbonate is used up and brought to a normal level (alkalosis).

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This is the best explanation do with the small space available on Instagram. How many of you would like an article on this? Let us know in the comments!

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Emergency Services Mythbusters

We all hear misconceptions about our jobs on a regular basis. Rather than moan about it, I thought I would make this post debunking those myths to help educate the general public. So listen up!

Myth 1: If an ambulance takes me to the hospital I won’t have to wait (EMS) Wrong! The speed at which you are seen at the ER is based upon your condition, your symptoms, and whether anyone else around you is more urgent. This isn’t a first come first serve situation, this is one where the urgent patients, who don’t have time to wait, are seen first. If you don’t want to wait and don’t have life threatening symptoms, I recommend waiting to see your doctor or visit an Urgent Care. I have wheeled many a patient into the waiting area on a gurney, we are not a free pass to a room.

Myth 2: Go to the ER when you run out of medications (EMS/ER) Wrong…usually. If you run out of medications you need to contact your prescribing physician or your pharmacy. If you have mental health issues, run out of medications, and feel you are a risk to yourself or others, absolutely take a trip to the ER. They will make sure you stay safe and evaluate your condition.

Myth 3: First Responders judge patients (EMS/LE/Fire) Wrong! I guarantee you we have seen worse/more ridiculous things than you are calling for. Sure, we may chuckle about some things later on, but we are not judging you personally for what you called for. You are our citizens and if you feel you are in an emergency situation we will be there and do our best for you. You aren’t the first naked patient we have seen, not the first weird object in an orifice, and you are not bothering us by calling.

Myth 4: Firefighters are just firefighters (Fire) Wrong! In many jurisdictions your local Firefighters are also EMTs or Paramedics! Ever wonder why you get a fire truck when you called for an ambulance? That’s why! Firefighter/Paramedics are some of the smartest people I know!

Myth 5: Taxpayers have to pay for groceries and televisions (Fire) Wrong! If you see your local Firefighters shopping at the grocery store alongside you on duty, that food is coming out of their pockets! Usually the crew will each put down x amount of money for the day and then cook together. Aside from the basic necessities in the living area, most of the contents are either donated/bought by Firefighters or by the Union. This includes the televisions, lounge chairs, mattresses, etc. And if we are going to bring up the taxpayer argument, we pay our taxes too(;

Myth 6: You can sleep all day (Fire/EMS) Depending on your department/response area! There are some departments out there who are both not busy at all and are lazy, and they probably do sleep all day. However, the vast majority of us are either very busy or fill the downtime with training and continuing education! Where I worked, we generally ran between 16-20 calls in a 24 hour shift. If you average each call out to about an hour, that leaves us 4 hours of downtime to sleep and eat. Sleep is a precious luxury for Fire/EMS.

Myth 7: You have to be heartless (Fire/EMS/LE) Very wrong! You do not get into, or last, in this career without caring about people. I don’t care if you are a Firefighter, EMT, Paramedic, or LEO…your basic job description is to serve the citizens. Sure, we know how and when to shut our emotions off to do our jobs. When your child is sick the last thing you want is a sobbing, bumbling mess of a responder. That being said, we definitely feel empathy for our patients.

Myth 8: You are basically doctors/You are basically a taxi (EMS) This myth tends to go one way or another. Either people think we are unskilled morons, or they think we are directly out of General Hospital and can cric someone with a ballpoint pen and a pocket knife. The truth is somewhere in the middle. Even EMTs (The entry level certification for EMS) are trained in life saving measures and are fairly knowledgable about medicine. Paramedics are jacks of all trades. They can give you medications, take over your breathing with a tube down your throat, monitor and read your heart rhythms, and many other things. That’s even more than RNs in many cases (Apples to oranges y’all, just for reference).

Myth 9: I bet your job is really exciting (Fire/EMS/LE) Yes and no. Our job can be very exciting at times. You have your days or your calls where the adrenaline is pumping and you get to feel like a hero. You have other days where all you run are BLS falls, fire alarm activations, or social-worker-like calls.

Myth 10: First Responders cannot get PTSD, they aren’t soldiers This one is thankfully on its way out of this list, but it is still present. There are genuinely plenty of people, who don’t understand our jobs, that believe only our military members can develop PTSD. PTSD can come from being involved in any traumatic event, and if affects each person differently than the next. The reality is that almost 40% of us have been diagnosed with a mental health disorder secondary to the things we see on a daily basis, and that’s not including all those who refuse to get help. Don’t worry though, we are all very highly functioning individuals who you can absolutely trust with your emergency. We just have struggles in life like everyone else!

I hope this has helped educate some of you on your Emergency Services! Just remember we are always there to help and be safe! Please feel free to reach out to this page if you ever have any questions about what we do!

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Ambulance wins, everytime.

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incorrecthanniballecterquotes

Will: If I died how much would you miss me?

Hannibal: It‘s cute that you think death can get you out of this relationship.

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But you don‘t know how it feels to wake up and to have nothing to look forward to. You just try to make it through the day with the fear that something bad could happen again. You don‘t know how it feels to live with depression and anxiety.

(-deepthoughtsvibes)