# Shock questions



## dac534 (Oct 4, 2012)

Hello. I am new to the forum and have some questions. I am in EMT school and we are talking about shock and fluid replacement. I have read and read the powerpoints but still don't get some of the materials. So, I know some of the questions are kindergarten to you all but Im still trying to learn so sorry about that. 

So here is my questions,

Catecholamines: what affect do the have on the body? Do they just transmit signals to various receptors? And what chemicals are catecholamines?

Hypo, hyer and isotonic solutions: My teacher was explaining them and he lost me where hypotonic solutions should be used when your dehydrated. I thought the exact opposite. So please start from step 1 on that. 

Again, I know this is all small stuff but of all the things I don't get it has to be the small stuff I don't understand. I really appreciate you taking teh time to read and respond to this!


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## CondeEMT (Oct 4, 2012)

_In the human body, the most abundant catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline) also dopamine, all of which are produced from phenylalanine and tyrosine. Release of the hormones epinephrine and norepinephrine from the adrenal medulla of the adrenal glands is part of the fight-or-flight response. Catechol or epinehrine._ -Wikipedia.

SMH!!!

I am studying shock in my class right now tho i had to google catecholamines because i could not find it,not even in the texts index tho i know what ephiphrine can be a good thing for the body overall to maintain stasis in cases of anaphylactic shock. 


What book are you using?


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## CondeEMT (Oct 4, 2012)

I am studying from the AAOS 10th edition. or Orange Book.


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## Cup of Joe (Oct 4, 2012)

I think these are a little advanced for EMT (especially because we don't carry hypotonic solutions on the ambulances here), but I'm in a good mood today, and feel like helping.  




dac534 said:


> Catecholamines: what affect do the have on the body? Do they just transmit signals to various receptors? And what chemicals are catecholamines?



Catecholamines are simply a group of bodily hormones that all share a particular chemical make up (amino groups, hydroxyl group, etc).  These act as neurotransmitters, usually triggering the sympathetic nervous system (fight or flight response).



dac534 said:


> Hypo, hyer and isotonic solutions: My teacher was explaining them and he lost me where hypotonic solutions should be used when your dehydrated. I thought the exact opposite. So please start from step 1 on that.



Hypo usually means "lower" or "below", right?  So a *hypo*tonic solution is a solution that has less solute than the fluid around it (or on the other side of a membrane).  An example is 0.45% Sodium Chloride (Half Normal Saline).

Isotonic is simply the same amount of solute dissolved in it as the fluid on the other side of a membrane of the fluid around it.  An example is 0.9% Sodium Chloride (Normal Saline)

Hyper means "higher" or "above", so a *hyper*tonic solution has a higher solute concentration than the fluid around it.  

In dehydration, the blood becomes more concentrated because of the lower than normal amounts of water, the body "pulls" water into the blood from interstitial fluids.  Half normal saline is given and travels throughout the body, and osmosis causes the fluid to leave the blood stream and enter the interstitial fluids (replenishing it).  Half normal saline is using osmosis to replenish these extravascular fluids more quickly, as compared to using normal saline.

Hope that made some sense.


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## silver (Oct 5, 2012)

Cup of Joe said:


> Catecholamines are simply a group of bodily hormones that all share a particular chemical make up (amino groups, hydroxyl group, etc).  These act as neurotransmitters, usually triggering the sympathetic nervous system (fight or flight response).



Be careful with your terminology here. Catecholamines act as a neurotransmitters and hormones. The fight or flight response, or classically known as the sympatho-adrenal response, is more the result of the release of catecholamines from the adrenal medulla. Sympathetic neurons synapse at the adrenal glands.

Acting as a traditional hormone, epinephrine and norepi are secreted and floods the body. Adrenergic receptors on target tissue bind the epinephrine/norepi. This generally causes vasoconstriction, increased respiratory rate, and glucose and fatty acid mobilization. There are also a lot of other complexities that aren't worth mentioning.

Edit:
to add this is a very simplified way, but it points out the traditional hormonal action in acute stress response.


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## Brandon O (Oct 5, 2012)

dac534 said:


> Hypo, hyer and isotonic solutions: My teacher was explaining them and he lost me where hypotonic solutions should be used when your dehydrated. I thought the exact opposite. So please start from step 1 on that.



Great questions.

The idea here is, where will the fluid go? Fluid tends to follow solutes. If we add hypertonic solution to the intravascular space (e.g. mannitol into an IV), we're adding more solutes than solvent, and it will tend to draw fluid out of the other spaces to compensate. In other words, it'll dehydrate cells and tissues, which the opposite of what we want.

Conversely, adding hypotonic solution to the intravascular space (e.g. D5W into an IV) adds more solvent than solutes. So the fluid will tend to move out of the bloodstream into the cells and tissues, where dissolved solutes are at a higher concentration, in order to achieve equilibrium. So we're rehydrating the tissues that are dehydrated.

Imagine if we lost blood, however, and wanted to replace intravascular volume. Hypotonic D5W would be a terrible choice, because most of that volume would quickly leave the intravascular circulation.

Think about where you want the fluid to go. This idea is called the "volume of distribution."

Keep scratching your noodle, these are great questions.


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## VFlutter (Oct 5, 2012)

To keep it simple cathecholamines (Epi) increase heart rate, vasoconstrict, and broncodilate. In relation to shock it is a compensatory mechanism to maintain homeostasis. So in anaphylaxis the primary problems are bronchospam and vasodilation. Epi works to conteract the process to maintain an adequate blood pressure and airway. In hemorrhagic shock there is a decrease in blood volume so the body uses Epi to vasoconstrict, which brings more blood back to the heart and vital organs, and increases the heart rate which increases cardiac output to make up for the loss in volume. 

That is totally oversimplified but as a Basic there really isn't any point for going into the details. Until you have taken a biology or patho class you will be lost.  


On a somewhat related side note. One of my patients this week had a pheochromocytoma. Cathecholamine surge = crazy hypertension


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## dac534 (Oct 5, 2012)

First of all, thank you to everyone who has posted. Its really helping me understand this. So I am going to try and explain it teh best way i can and you all can tell me if I am right.

 Catecholimines are just norepi and epi. Correct? If that was the case, I was sitting here reading the same slide over a hundred thousand times. I knew exactly what norepi and epi is.  So pretty much Epi/nor epi is Catecholimine. Catecholimine is Epi/nor epi. And so all the catechoimines do are: bronchodialtion, increased heart rate, increased respiratory.... pretty much "fight or flight". If I am wrong please stop me and explain where. 

And the solutions, a solute will disolve a solvent. A solvent is what a solute will disolve. Correct? So, the hypertonic solution will hydrate cells by taking liquid from more hydrated cells and moving them to a lesser hydrated cell. Hypotonic will take water from the actual blood stream itself and give it to the cells. Isontic im still confused on. Im sorry got being so dang complicated but I need to try and understand this.


I don't know how your alls classificatipons of EMT levels are, but I am in TN and we still have the First Responder, basic, IV tech and EMT paramedic. SO I am trying to be an IV tech. My protocols are allowing me to give 9 drugs(10 including oxygen).Like I said I am probably repeating myself but I don't know how your states classifications are but incase you didnt know I went ahead and explained it. Again, thanks for all the help and taking your time to explain to me all this stuff. Its really helping me to get the big picture.


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## VFlutter (Oct 5, 2012)

And Dopamine. Also don't forget vasoconstriction. Those are the big 3 but they also have other sympathetic effects such as pupil dilaton and sweat secretion. So basically the "fight"


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## Veneficus (Oct 5, 2012)

Just so you know, you are not asking questions about shock.

You are asking questions about vascular tone and volume. 

That is 1/3 of 1/2 of shock.

The fluid dynamics you are asking about does not go from more hydrated cells to less hydrated cells. 

It moves from either:

intravascular to extracellular to intracellular 

or

intracellular to extracellular to intravascular


Isotonic hopefully maintains no net movement of water. 

I strongly urge you to pick up a copy of of Guyton's Medical Physiology. That book is written as if the reader understands nothing and it goes step by step through the processes.

I think you will have more success with that.


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## Brandon O (Oct 5, 2012)

dac534 said:


> First of all, thank you to everyone who has posted. Its really helping me understand this. So I am going to try and explain it teh best way i can and you all can tell me if I am right.
> 
> Catecholimines are just norepi and epi. Correct? If that was the case, I was sitting here reading the same slide over a hundred thousand times. I knew exactly what norepi and epi is.  So pretty much Epi/nor epi is Catecholimine. Catecholimine is Epi/nor epi. And so all the catechoimines do are: bronchodialtion, increased heart rate, increased respiratory.... pretty much "fight or flight". If I am wrong please stop me and explain where.
> 
> And the solutions, a solute will disolve a solvent. A solvent is what a solute will disolve. Correct? So, the hypertonic solution will hydrate cells by taking liquid from more hydrated cells and moving them to a lesser hydrated cell. Hypotonic will take water from the actual blood stream itself and give it to the cells. Isontic im still confused on. Im sorry got being so dang complicated but I need to try and understand this.



Have you taken a chemistry or biology class that describes diffusion and osmosis? If not you're going to have a difficult time with this. You're essentially asking questions that go to the underlying principles involved. I don't mind trying to give a "Sparknotes" summary, but you'd be better off going back to the foundational material (or reviewing it, if you've learned it before).

The catecholamines are essentially epi, norepi, and dopamine. (The first two are also referred to with the term "adrenergic.") They're hormones, so they're released into the bloodstream and hit all the organs and tissues. But they do different things at each location. The different effects are caused by different receptors within, for instance, your lungs and your skin. So as they hit the lungs, they cause the smooth muscles to relax -- bronchodilation. But as they hit the skin, they cause smooth muscle to constrict -- vasoconstriction. Same hormones, different receptors.

The catecholamine response is part of the sympathetic system, which is perfectly sensible to think of as the "fight or flight" response. The opposite is the parasympathetic response, which mostly uses acetylcholine -- the "rest and digest" effect. You can get pretty far trying to predict the effects of each on a certain organ system, based on the "would this help me battle a wooly mammoth, or chill out afterwards?" approach, but some of the effects aren't intuitive. Here's a summary:







As for fluids: you have a few things off. Something dissolved in something is called a SOLUTION. The SOLVENT dissolves the SOLUTE, or the SOLUTE is dissolved into the SOLVENT. So water might be the solvent and sodium chloride (NaCl) might be the solute, making a solution of saline.

If I farted in the corner of your room right now, the fart (solute) would not stay in the same spot of the room's air (solvent). It's high concentration there, and low concentration where you are. So it would gradually spread out until it was at the same concentration throughout the room. This is called diffusion.

The same thing happens in liquids. If you drop that NaCl into some water, it will gradually diffuse through it until it's at equilibrium (all the same). This is just a natural effect due to the random movement of particles.

If you placed a membrane across the water, one that allowed for particles of water and/or NaCl to cross it, this process would still occur. As long as the concentration on both sides is different, NaCl and water will diffuse in opposite directions across the membrane; where there's more NaCl, it'll move across to where there's less, and where there's more water, it'll move the opposite way. The side with more solute (NaCl) is _hypertonic_, the side with less solute is _hypotonic_; if they're equal, they're both _isotonic_. These terms are relative, so they only have meaning when compared to something. When we say an IV solution is hypertonic, we mean compared to the fluid in a normal human body.

The important point is that water tends to follow solutes; it moves toward areas of high concentration in order to dilute them and achieve equilibrium. In the above example, the solute itself also diffused the opposite way, and this happens in the body too, but water is usually much more mobile. The "membrane" in the body is the walls of the blood vessels, the plasma membrane of the cells, etc.

So a hypertonic solution has more solute (stuff) than the solution that's inside your cells. We add it to your blood. Since your blood is now more concentrated than your cell contents, water will move out of the cells and into the blood. The cell is now dehydrated and your blood volume is increased. If we'd added a hypotonic solution, the opposite effect would occur; water would move out of the blood and into the cells to chase the higher concentration of solutes there.

This is a seriously :censored::censored::censored::censored::censored::censored::censored:ized explanation, and I'm trying to decide what to elucidate and what to leave out, but hopefully it makes some sense.


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## silver (Oct 5, 2012)

Brandon Oto said:


> Have you taken a chemistry or biology class that describes diffusion and osmosis? If not you're going to have a difficult time with this. You're essentially asking questions that go to the underlying principles involved. I don't mind trying to give a "Sparknotes" summary, but you'd be better off going back to the foundational material (or reviewing it, if you've learned it before).
> 
> The catecholamines are essentially epi, norepi, and dopamine. (The first two are also referred to with the term "adrenergic.") They're hormones, so they're released into the bloodstream and hit all the organs and tissues. But they do different things at each location. The different effects are caused by different receptors within, for instance, your lungs and your skin. So as they hit the lungs, they cause the smooth muscles to relax -- bronchodilation. But as they hit the skin, they cause smooth muscle to constrict -- vasoconstriction. Same hormones, different receptors.
> 
> ...



Some things should be clarified here. In general, Na and Cl ions will not go across the membrane into the cells very much. This is what causes the driving force for water to move in and out.

To add what you said:
Essentially there is are solutes on each side that can't more or less can't go across. At all times the membrane will try to balance the overall concentration of solutes by letting water move across. The variable once balanced will be the volume of water. If you have a higher concentration of solutes on one side, water will flow to that until both concentrations are the same.


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## dac534 (Oct 5, 2012)

I think after reading this over the fourth time something clicked for me. Here is how I am picturing this in my mind. I know its kind of kindergartenish but for some reason I was just not getting this. "salt and taxis". Ok. So, we have our blood vessel. We have our cell. The cells have got a whole bunch of salt in it. The blood vessels are hypotonic so therefore the taxi(water) is going to move to the cell to deliver the salt to where it needs to go. Our cell is filled with salt, so we are dehydrating that cell by taking salt out and equalizing the salt content of the vessel and the cell. Running .45 NS would do this. Homeostasis. There is our hypotonic solution. 

Hypertonic exact opposite. blood vessel has more salt in it, the cells need rehydrated. So the taxi(water) is going to bring the salt into the cell so there will be an equal concentration in both the cell and vessel. So now if we have equal(homeostatic) concentrations, we are just fine and dandy. Have our cake and eat it too. Run some NS and we are having a great day. I think part of what was throwing me off was I think my teacher had the exact opposite of what you all was explaining. And I quote" Solvent- a substance in which a solute will dissolve. Solute a substance that dissolves a solute". That sounds completely bass akwards to me. But he could have been in a hurry. So, could you all please tell me if my small brain has finally comprehended this? 

I feel pretty dumb, seriously after taking that long to try and figure this out. When I took chemistry I had a 95 at least average. I used to teach people, help with homework all that good stuff. What happened I don't know. I am hoping I got this all right now. That would be alot of weight off my shoulders for our test Monday.


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## dac534 (Oct 5, 2012)

So osmosis occurs 99.9% of the time? The content is pretty much the same in the cell and the vessel. BUT where salt goes water follows, if there is no water in a cell, the water will move into the cell to make it homeostatic. Is that what you are saying?


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## silver (Oct 5, 2012)

dac534 said:


> So osmosis occurs 99.9% of the time? The content is pretty much the same in the cell and the vessel. BUT where salt goes water follows, if there is no water in a cell, the water will move into the cell to make it homeostatic. Is that what you are saying?



The saying "where salt goes water follows" isn't literal in this sense.

Okay so lets generalize and simplify this.
-When we say blood, we mean anything outside of a cell.
-The major components, solutes, outside of the cell and inside the cell are different. Generally speaking Na and Cl like being on the outside and K and PO4 on inside.
-The overall concentration of components of things that can't go through the membrane easily (osmolarity) will always try to equal itself. Thus creating a drive for water to move (osmotic pressure) to make sure this concentration equals each other.

So lets say the concentration when you start is 100 on both sides, balanced. You add hypertonic (meaning has a higher osmolarity than your reference) solution to the outside of cells, blood. Theoretically this makes the outside 104. The inside is 100. The solutes can't go through the membrane...so what needs to happen? Water has to go where the higher concentration is. Lets say it balances it at 102 (higher than starting as we added hypertonic). Inside the cells will have less water now though as it left. And the reverse is true when you add hypotonic.

Its hard to explain the concepts without any of the meaty stuff. Understanding osmolarity and osmotic pressure may be a good place to start.


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## hogwiley (Oct 5, 2012)

Im surprised this is something covered in EMT school. Its not like youre going to be giving IV fluids. Of course it probably doesnt hurt to know this stuff as it might help you decide when ALS should get involved. 

My EMT class didnt cover any of this stuff. It wasnt until I took an A&P class at a community college that I was forced to think about things I learned years ago in high school chemistry.


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## Veneficus (Oct 6, 2012)

funtimes said:


> Im surprised this is something covered in EMT school. Its not like youre going to be giving IV fluids. Of course it probably doesnt hurt to know this stuff as it might help you decide when ALS should get involved.
> 
> My EMT class didnt cover any of this stuff. It wasnt until I took an A&P class at a community college that I was forced to think about things I learned years ago in high school chemistry.



There has been a considerable basic science element added to EMT Basic in the national curriculum. 

PH balance also needs to be taught. 

As I have said many times, the problem is most of the instructors do not understand this material because they became instructors after X years of field experience, not X credit hours of science education.

The EMS textbook publishers have exacerbated this problem by coming up with disconjoined bullet points and "spark's notes" for teaching material to market. 

So it is often presented as disconjoined facts to memorize instead of cohesive understanding.

What you see in this thread is the result. 

It stands to reason if many high schools where I am from teach basic chemistry in 10th grade and your EMS text (Basic EMT) is written at 8th grade, there is going to be a problem like this. Especially if your teacher just memorized a bunch of bullet points. 

It is part of the reason I suggested a text that would help instead of trying to teach basic chemistry over an online forum.

I like to help, bu thtere has to be a basic understanding to help. Given the most basic errors presented here, it is my guess the problem is this topic was not properly taught to the poster. 

If you really want to help, it will have to go back to the beginning. "This is an atom, This is an ion" level stuff.

I would also like to add to the explanation, solubility is not random it takes a certain amount of solvent to seperate each particle of solute especially in water, it is a constant motion in order to accomodate as much as possible.

I think one of the biggest problems in teaching medicine is the idea of teaching it as static events. 

One of my best professors likes to say "The human organism is a chemical reaction in a watery medium." (He is a biochemist can you tell?)

Anyway, as I said, consult Guyton's, that will help the most.


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## Brandon O (Oct 6, 2012)

Thanks for tagging in silver.

dac, go with his model. The key factor here isn't the movement of salt (which occurs, but not much, and isn't what you're interested in anyway). It's the movement of water. When there's more water and less solute, water moves to the other side until concentrations are equal. So we can manipulate the concentration of whatever we're giving in order to control which direction we want the water to move.


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## VFlutter (Oct 6, 2012)

If you go on YouTube there is a channel called InteractiveBiology that may help you understand some of these concepts.


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## NYMedic828 (Oct 6, 2012)

ChaseZ33 said:


> If you go on YouTube there is a channel called InteractiveBiology that may help you understand some of these concepts.



+1. That channel is fantastic.




Veneficus said:


> There has been a considerable basic science element added to EMT Basic in the national curriculum.
> 
> PH balance also needs to be taught.
> 
> ...



We will never surpass this level we are at now unless we remove the vocational factor of EMS. (But im just agreeing with you)

You don't expect an electrician to understand physics. How can anyone expect an EMS provider to understand physiology.

Other emergency professions such as police officer and firefighters are perfectly fine being vocational because the tasks they perform can not truly be taught in a classroom. It needs to be learned by experience. Medicine is a science and needs to be learned in a classroom and furthered with experience. We do it the complete opposite.


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## Veneficus (Oct 6, 2012)

NYMedic828 said:


> Other emergency professions such as police officer and firefighters are perfectly fine being vocational because the tasks they perform can not truly be taught in a classroom. It needs to be learned by experience. Medicine is a science and needs to be learned in a classroom and furthered with experience. We do it the complete opposite.



Beleive me, while it is easy to simply answer the question as it was posed here, the reason I didn't is because I already see that as this person has more unrelated facts heaped onto his shoulders to memorize, they will all get confused and there will be some very bad testing experiences in the future. 

While the "quick way now" seems like a reasonable solution to this chapter, wrote memorization at any level of medicine will not overcome base knowledge deficit.

Taking extra time to learn things right will not only help pass tests in the future, it will make for better patient care.

Anyone who has been to school for any length of time can tell you sometimes you have to take responsibility for yourself to overcome a poor instructor. (Not just in EMS schools) 

I offered the best long term solution. 

I picked that specific book for this thread because of the way it is written. It assumes you know nothing about chemistry or biology, and explains it to you step by step in an easy to understand, easy to read way. (with pictures)


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## VFlutter (Oct 6, 2012)

This will not be helpful for the OP but here are a few diagrams out of my textbook that I found helpful understanding the processes behind the various types of shock. 



























Courtesy of Pathophysology: The Biologic Basis for Disease in Adults and Children by McCance


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## Veneficus (Oct 6, 2012)

Somebody has to pay me to write a textbook or chapter on shock...


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## VFlutter (Oct 6, 2012)

Veneficus said:


> Somebody has to pay me to write a textbook or chapter on shock...



I pledge $5 to the cause.....


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## Veneficus (Oct 6, 2012)

ChaseZ33 said:


> I pledge $5 to the cause.....



That isn't going to buy much.


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## VFlutter (Oct 6, 2012)

Veneficus said:


> That isn't going to buy much.



Could I buy a vowel?


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## silver (Oct 6, 2012)

Veneficus said:


> Beleive me, while it is easy to simply answer the question as it was posed here, the reason I didn't is because I already see that as this person has more unrelated facts heaped onto his shoulders to memorize, they will all get confused and there will be some very bad testing experiences in the future.
> 
> While the "quick way now" seems like a reasonable solution to this chapter, wrote memorization at any level of medicine will not overcome base knowledge deficit.
> 
> ...



That book was one of the "required" readings for my classes. I looked at it just now. I agree its pretty good in explaining this. I realize I gave out a lot of information, but the complexity of it all is just very great. Thats why I agree, a book would be very beneficial to anyone. Especially if they plan to go further.


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## Brandon O (Oct 6, 2012)

ChaseZ33 said:


> This will not be helpful for the OP but here are a few diagrams out of my textbook that I found helpful understanding the processes behind the various types of shock.



You... found that helpful?


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## dac534 (Oct 6, 2012)

funtimes said:


> Im surprised this is something covered in EMT school. Its not like youre going to be giving IV fluids. Of course it probably doesnt hurt to know this stuff as it might help you decide when ALS should get involved.
> 
> My EMT class didnt cover any of this stuff. It wasnt until I took an A&P class at a community college that I was forced to think about things I learned years ago in high school chemistry.



What I am studying for is EMT IV. In TN, we have a First Responder, EMT Basic, EMT IV tech., and an EMT Paramedic. I will(hopefully!) be one step under a medic, so therefore my protocols will allow me to give ten drugs(11 including oxygen) without calling for orders. Those include: Aspirin, Nitro, benadryl, D50, Activated Charcoal, Albuterol, Xopenex, Epi 1:1000, Oral Glucose and NS(oxygen too). So therefore thats why I am needing to understand fluid balances. I know I am killing you all but man this is tough for me. 

Let me say this. I could tell you how all this works because I "memorized" the explanation. What is getting me is I am not completely understanding the concept. I don't know about you all but I want to fully understand everything one step above what I need to know. I like to be comfortable giving fluids, or D50 or whatever. I guess you could say I am trying to overachieve when I shouldn't be. I just want to get the whole picture and make sure I am giving my patient the best possible care I can give. I don't know your alls protocols on what you can administer but it sounds like you all are either medics or the emt 99 or whatever they  are. 

I have looked at that book and have decided to try and get it. I hopefully understand what i need to at this point in time. Im not where I really want to be but Im hoping I can build on it as time goes by. I know you all are about ready to hunt me down and choke me but I am learning(slowly but surely). I definetly understanmd it more than I did. But please be patient with me. Thanks for everybody who has explained all this. Keep writing. I like reading about the different ways of how everybody explains things. Ill get to be as smart as you all maybe one day.


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## dac534 (Oct 6, 2012)

Another thing, what kinds of medications are you all able to give and what techniques are you able to perform according to your protocols? I assuming you all are medics so you can intubate, start IVs, decompressions..... but on my level of care, I want to compare the differences.


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## Tigger (Oct 6, 2012)

Why is it "10 (11 including oxygen)?" Oxygen is just as much of a medication as all the others listed.


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## dac534 (Oct 6, 2012)

Tigger said:


> Why is it "10 (11 including oxygen)?" Oxygen is just as much of a medication as all the others listed.



I knew oxygen was a medication but I was talking about actual "pills or solutions" you give.


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## silver (Oct 6, 2012)

dac534 said:


> Another thing, what kinds of medications are you all able to give and what techniques are you able to perform according to your protocols? I assuming you all are medics so you can intubate, start IVs, decompressions..... but on my level of care, I want to compare the differences.



so there are varying levels of care providers here. From people with barely any protocols (like me and I may even let my EMT lapse), to people who could make the protocols. It just goes to show the value of knowledge through proper education methods.


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## Brandon O (Oct 7, 2012)

dac534 said:


> Another thing, what kinds of medications are you all able to give and what techniques are you able to perform according to your protocols? I assuming you all are medics so you can intubate, start IVs, decompressions..... but on my level of care, I want to compare the differences.



I'm a Basic in Massachusetts. Including the optional protocols available at my company, we give aspirin, nebulized albuterol, epi autoinjectors, nasal naloxone, and oral glucose on standing orders; we assist with nitro and rescue inhalers; and we give activated charcoal with med control.


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## Tigger (Oct 7, 2012)

Brandon Oto said:


> I'm a Basic in Massachusetts. Including the optional protocols available at my company, we give aspirin, nebulized albuterol, epi autoinjectors, nasal naloxone, and oral glucose on standing orders; we assist with nitro and rescue inhalers; and we give activated charcoal with med control.



I would like nebs where I work, sadly I don't think this will happen anytime soon. We are getting nasal naloxone though.


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## dac534 (Oct 8, 2012)

Well, todays the test. Hopefully I have studied this forum enough to pass it with flying colors. Im pretty sure fluid maintenance will not b e a problem. I will let you all know how I do.


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## Anjel (Oct 8, 2012)

dac534 said:


> Well, todays the test. Hopefully I have studied this forum enough to pass it with flying colors. Im pretty sure fluid maintenance will not b e a problem. I will let you all know how I do.



You should be studying your book, not what a bunch of strangers on a forum say. Your test will be based on your book.


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## silver (Oct 8, 2012)

Anjel1030 said:


> You should be studying your book, not what a bunch of strangers on a forum say. Your test will be based on your book.



I've been known to lie before.

Deceit Level: 100

h34r:


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## VFlutter (Oct 8, 2012)

Anjel1030 said:


> You should be studying your book, not what a bunch of strangers on a forum say. Your test will be based on your book.



True story. I always get tricked by dumb questions that were taken word for word out of the text. The right anwser is not always the right anwser when it comes to tests. 


Try taking a nursing exam, you wouldn't believe some of the BS they consider "The most correct awnser"


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## Akulahawk (Oct 8, 2012)

ChaseZ33 said:


> True story. I always get tricked by dumb questions that were taken word for word out of the text. The right anwser is not always the right anwser when it comes to tests.
> 
> 
> *Try taking a nursing exam, you wouldn't believe some of the BS they consider "The most correct answer"*


The questions are written so differently than anything I've ever seen before, but once you figure out what they're asking for, then you simply have to figure out which one is the most right... which can be a pain. The ones I really dislike are the "choose all that apply" and of course, those are the ones that are all "most correct." The others are almost correct...


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