Monitoring potassium

xavieralexander

xavieralexander

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my protocol= not to exceed 20 mEq/1000cc or more than 10 mEq/hour


I'm confused on this homework question:
You are sent to transfer a patient from your local clinic to the large hospital in a near-by city. The patient has an IV of 20 mEq KCL in five liters of normal saline on 10 gtts tubing. It is currently running at 100 gtts/min on an IV pump, which you will go with you on the transfer.

the answer says I can run as high as 855gtts but I don't know how they get that.

I thought I would cut the 5L in half to make it 2500mL(10mEq) then multiply that by 10gtt and divid that by 60 but it comes out to 416gtt.
 
I've got a feeling there's a typo there. You will never see a 5L bag of NS for IV drip. For irrigation, yes, but it's not for IV.

EDIT: And also, last I checked EMT-Is in NM were not allowed to use an infusion pump. Dial-a-flow or counting drips are the only ways we can do it. I'll look again though.
Where are you taking EMT-I? And you working yet for any service?

EDIT2: Just checked, infusion pumps are only listed on the SOP for EMT-P level. Not EMT-I. So since it says it's on a pump the answer should be cannot take as given.
 
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Im not currently working still applying to jobs. i just got my EMT-b license 3weeks ago!

As of now I'm still in school working towards the EMT-I

I hope its a typo but I think it was a question to throw us off and make us think because the question before it is "The patient has an IV of 20 mEq KCL in 500 cc of normal saline on 10 gtts tubing." and asks can you transport???

your right we have to either have a medic or have doctor change the drip before we transport we can only monitor.
 
Heh yea that one you need to ask your instructor about. It's either a typo or they just wanna make sure people are reading it.

BTW, if you don't mind workign in a rural county, I know of one service (the one I work for) that might still be looking for basics.
 
TransportJockey said:
I've got a feeling there's a typo there. You will never see a 5L bag of NS for IV drip. For irrigation, yes, but it's not for IV.

EDIT: And also, last I checked EMT-Is in NM were not allowed to use an infusion pump. Dial-a-flow or counting drips are the only ways we can do it. I'll look again though.
Where are you taking EMT-I? And you working yet for any service?

EDIT2: Just checked, infusion pumps are only listed on the SOP for EMT-P level. Not EMT-I. So since it says it's on a pump the answer should be cannot take as given.
Click to expand...

Interesting that a notoriously unreliable and inaccurate device like a dial-a-flow, and the inherently unreliable and inaccurate counting-drop methods are allowed and a reliable and accurate device is not. I understand the SOP argument, but it doesn't make a whole lot of sense.

Also, if there's any concern at all, there's no really good reason not to D/C the K+ drip before transport and have them start it back up at the destination facility. In most cases, this is purely for maintenance (and frequently not needed anyway) and the patient will do fine without it for a few hours of transport.
 
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I've had that same discussion with my instructors and one or two people from the state office. They are working to change it... although it's a rare case when an ILS truck takes a patient that's on K+ anyways.
 
I agree something is wrong with the question. That can not be a real concentration. Sounds like an error.
 
While the question sounds like an error... My stock answer to this is simple. Know your protocols and scope of practice limitations. If you're allowed to use a pump, great. Know how to use it proficiently. Know what to do if the pump fails or if you're not authorized to monitor fluid delivery via pump. Know what fluids (and concentrations of them) you can legally transport. Remember, 20MEq of K+ in 5L has a much lower K+ concentration per mL than 20MEq of K+ in 500mL does...

Incidentally, I've had dial-a-flow devices break... more than once on the same trip. I always calculate the gtts/min anyway and also monitor how much fluid is being administered as a backup to that too... even if the patient is on a pump. Why? What if the pump fails...
 
xavieralexander said:
my protocol= not to exceed 20 mEq/1000cc or more than 10 mEq/hour


I'm confused on this homework question:
You are sent to transfer a patient from your local clinic to the large hospital in a near-by city. The patient has an IV of 20 mEq KCL in five liters of normal saline on 10 gtts tubing. It is currently running at 100 gtts/min on an IV pump, which you will go with you on the transfer.

the answer says I can run as high as 855gtts but I don't know how they get that.

I thought I would cut the 5L in half to make it 2500mL(10mEq) then multiply that by 10gtt and divid that by 60 but it comes out to 416gtt.
Click to expand...

What is actually the question? How fast you can run the drip before you exceed your protocols?
 
Sounds like a med math question. The numbers are going to be crazy because it is not a realistic situation to begin with.
 
Here is the exact question

You are sent to transfer a patient from your local clinic to the large hospital in a near-by city. The patient has an IV of 20 mEq KCL in five liters of normal saline on 10 gtts tubing. It is currently running at 100 gtts/min on an IV pump, which you will go with you on the transfer.
A. Does the concentration meet the first stipulation for KCL?
B. Does the nurse need to adjust the drip rate?
C. If the rate needs to be adjusted, what is the new setting?

answer.
A=Yes
B = No
C = No could go as high as 855 gtts

I understand A and B but I cant figure out how they got 855
 
Glad to see it's a reality based question :rolleyes:...
 
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