# Drug Calculation Apps - Do you use them in the field?



## medickat (Feb 28, 2012)

I was taking a look at iphone apps that will do medical math for you in the field. Being not so great at math, and in medic school, I'm a little concerned about this aspect of the job. So I'm looking for opinions - do you use these apps or know anyone who does? How accurate are they? If you have used them, have you had patients react negatively to the fact that you're looking at your phone when you're supposed to be taking care of them?


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## NomadicMedic (Feb 28, 2012)

I have them, don't often use them, but I do occasionally double check my math with them. 

And no patient that needs drugs calculated is going to be in any condition to say anything about my phone, as I would only use it to double check dopamine or an odd RSI dose.


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## DrankTheKoolaid (Feb 28, 2012)

*re*

While there is no reason for you not to have a backup way of confirming your drug dosages, you need to learn to do them on paper or on a calculator first.  Otherwise how are you going to know if the app is making an error or not if you cant even ball park the figure in your head.  

Medic math can be daunting while in school and if like the program I help at you will be absolutely forced to learn to do it on your own.  But.... you should be shown multiple ways of coming to the correct answer so you can find a math style that fits you.

Then once in the field you will learn all the shortcuts and for coming to the same answers in seconds in your head.  Dopamine, Epi infusions, Lido Infusions, etc etc etc in your head in seconds.  

But until then learn to do it yourself, you will thank yourself later when your not stressed the first time you run a Mag drip and have to convert the 50% into a 10% and then run it over 20 minutes with nobody to bounce your answer off of.


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## Pavehawk (Feb 29, 2012)

Just finished some CE stuff on pediatrics and one of the sessions was on medication dosage errors. The folks doing this class are of the opinion that math in your head has no place in emergencies. They suggest using apps, preprinted charts, pocket references, BLT, or PC systems (in the ED) etc.

Not all of this was applicable to the field but the main point is that unless you are using this daily (pediatrics ED) you are not going to be proficient enough when the fecal material hits the rotating air movemnt device.

So my actual answer to you is yes there are apps and you can use them, and in some systems (Wake County comes to mind) they have preprinted doages cards for pedi stuff, but as has been pointed out you still need to learn the math (at least for testing!!) 

Check out this site for a look at one of the systems being used by some folks.

www.ebroselow.com/prd/static/artemis.asp

Hope this helps you, good luck in school I'm a mathphobe too!


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## MSDeltaFlt (Feb 29, 2012)

I'm not a big fan of apps.  Never was even when I was flying.  Medic math is nothing more than high school algebra.  So figuring out a pt's dose based on weight is the use of 2 simple formulas: pounds to kilos, and mg/kg on basic drugs. 

For dopamine, dobutamine, propofol, etc you use a slightly more complex formula:

Dose X kg X gtt / concentration = CC/hr

If you're on a transfer with a pt on a weight based drug drip and you need to make sure they're on the right dose, then the method used to prove that we were all taught in grade school: what is multiplied on one side of the "=" sign will be divided by on the other side and vise versa.

The only thing a medic needs besides his brain is a calculator and the protocol book.  This stuff only takes 5min max.


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## phideux (Mar 1, 2012)

It seems like we are raising a generation that cannot function unless the phone is permanently attached to the hand 24/7. In my opinion EMS is a 2 handed job, keep the phone in your pocket. It looks unprofessional to whip out your phone in the middle of patient care. The math involved with drug dosing ain't that hard, take the time to master it instead of looking for an app for it.


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## usalsfyre (Mar 1, 2012)

phideux said:


> It seems like we are raising a generation that cannot function unless the phone is permanently attached to the hand 24/7. In my opinion EMS is a 2 handed job, keep the phone in your pocket. It looks unprofessional to whip out your phone in the middle of patient care. The math involved with drug dosing ain't that hard, take the time to master it instead of looking for an app for it.



OOOOORRRRRRR......

We can recognize that manual calculations are prone to error and utilize engineering controls (such as a calculator) to reduce the risk of that error and stop getting so wound up over something that is accepted among the rest medicine.


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## Sasha (Mar 1, 2012)

phideux said:


> It seems like we are raising a generation that cannot function unless the phone is permanently attached to the hand 24/7. In my opinion EMS is a 2 handed job, keep the phone in your pocket. It looks unprofessional to whip out your phone in the middle of patient care. The math involved with drug dosing ain't that hard, take the time to master it instead of looking for an app for it.



I would rather someone use a phone that isn't going to do the math wrong them someone sit there and try to do it in their head in the middle of an emergency. 

I whip my phone out often but usually to check spelling or find a word for what I want to describe. Sometimes I have a brain freeze and can't think of the word. I wouldnt hesitate whipping it out for drug calc. 

I think those who do have a problem are generally older and jealous they didn't have something like that when they were younger paramedics.


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## johnrsemt (Mar 1, 2012)

Funny;  they don't allow residents and doctors to do the math in their heads:  they make them use preprinted cards (not the ones that they make, but professionally from a company), calculators, and protocols; or formula apps on their phones, ipads, ipods or PED's.  That is professional.

   But it isn't professional for a paramedic to do the same thing.


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## MSDeltaFlt (Mar 1, 2012)

phideux said:


> It seems like we are raising a generation that cannot function unless the phone is permanently attached to the hand 24/7. In my opinion EMS is a 2 handed job, keep the phone in your pocket. It looks unprofessional to whip out your phone in the middle of patient care. The math involved with drug dosing ain't that hard, take the time to master it instead of looking for an app for it.



EMS is more than a two-handed job.  It is a critically thinking job.  Now there a four tools a good medic should always use and in this order.

Your brain: think critically and use common sense.

Your protocol book: especially when using multiple protocols and when your pt falls out of protocol

Your calculator: some drugs are weight based and NOT titrated to effect.

Your phone: for Dispatch and OLMC.

There are very few times when a paramedic has no time whatsoever to be distracted by the technology of his phone. Those times are during the recognition and treatment of immediate life threats: A, B, & C - intubation, cricothyrotomy, needle decompression, CPR, defibrillation, etc.  Beyond that you've got time to utilize the 2, maybe 5, minutes to pull out your calculator and your protocol book (if need be) and calculate the proper drug(s) and the proper dose(s).

And Sasha made a good point: internet.  There are new drugs coming out all the time. Some old drugs from new companies with new trade names.  Different drugs react differently with each other.  If there's a drug you're not familiar with and you have time enroute, Google and the like comes in pretty handy.

In the immortal words of Right Said Fred and reiterated by Powerman 5000, "Relax".  Using your phone to advocate for your pt is not unprofessional.


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## triemal04 (Mar 1, 2012)

Corky said:


> While there is no reason for you not to have a backup way of confirming your drug dosages, you need to learn to do them on paper or on a calculator first.  Otherwise how are you going to know if the app is making an error or not if you cant even ball park the figure in your head.
> 
> Medic math can be daunting while in school and if like the program I help at you will be absolutely forced to learn to do it on your own.  But.... you should be shown multiple ways of coming to the correct answer so you can find a math style that fits you.


Bingo.  If you are using pumps, the better ones will be able to calculate the flow rate and doseage for you.  If you've got a quick thinking agency they'll have a calculator somewhere in the rig for you to use.  Or you'll have one of your own.  Or you'll have something like a phone app.

And if you are a good provider you'll know how to function without those for those times when they break or are unavailable.

Someone allready said it; most calculations for med admin are pretty basic.  It really only get's more complicated when you're delivering a specific doseage that varies by weight over a specific time ie dopamine or dobutamine (or anything else that runs like that; there are lots).  You should be able to figure it out in either your head, or quickly with a paper and pencil.

If you can't...perhaps this is one of those times when you should reevaluate what you are doing...


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## phideux (Mar 1, 2012)

The majority of the drugs we use are in single dose vials, or single use pre-loads. 
We have our RSI dose chart on the wall of the ambulance.
For Pedi doses we have a Braslow tape.
For drips, remember the clock method.

Formula Apps are not 100% foolproof. Everyone knows how hectic it can get in the back of an ambulance. With the size of phones and keypads, or touch screens,  I bet it would be pretty easy to fat-finger a decimal point in a drug calc and give something in Mgs that should have been Mcgs, or the opposite.

Like stated medic math isn't that hard, 2 basic formulas cover just about everything. Most calculations can be figured out quicker than it takes to break out the phone and turn the App on.

Sasha, I am a little bit older, but not jealous.   I embrace technology, always have the latest phone, computer, etc. Sometimes technology don't really cut it. You know the old saying "treat the patient, not the monitor". Sometimes you need to go with whats in your head, not what an App tells you.


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