Podcast 43 - Are you a bolus master? Prove it! (Vodcast blog)
Before we get into the blog, be sure to post any great FOAMed medication math resources in the comments. And make sure you watch the vodcast at the end of the blog!
I posted a ‘Vodcast’ today about med math - fluid over time. I went over how to actually perform the very simple calculation, and a few examples of medications that you can use this for. I initially thought this would apply mostly to prehospital providers, but I actually got some feedback from in-hospital producers saying the manual medication math helps when pharmacy is not readily available during emergencies in the hospital. I am personally always impressed when someone can do their medication math manually (phone calculator, no app).
The other point I wanted to touch on was how to apply this in simulation. I’ve done a couple other blog posts on how to make simulation not suck, but I wanted to touch on the medication math part specifically. When I am running a scenario for trainees, students, or for employee competencies, I like to incorporate this. When the scenario gets to a point where it's time for the crew to dose a medication, if either crew member is having the slightest problem with the math (even on the IV pump), I open up the problem to the classroom. This accomplishes a few things. First, it doesn't make anyone feel bad, because it seems like the scenario was meant to go that way. Second, by involving the audience in the decision making of the simulation, they get more involved (I've found this generates great conversation and debate). Finally, it shows everyone that dosing medications is not easy where there is a little bit of pressure on you. Has it yielded any results?
The more I do these types of scenarios, the more often I'm seeing providers get the correct answers quickly. They are also making their own references so that the next time they run into a tricky dosing problem, they can reference their notes in their smart phones and figure it out quickly. Like I mentioned in the podcast, it's great to know the dose of a medication, but actually being able to carry out those desires is an entirely different challenge!
Challenge yourself! Go into your ambulance and find all the medications that are not a simple draw up and push. Then see if you know how to set up each one of those medications and set up all of their dosing ranges. How will you mix it? How many mL/h will it run at for your starting dose? What is the VTBI? What if you have to do a bolus dose during your infusion? Is there weight based and non weight based dosing? Can you figure all these things out for both? Keep in mind that it isn't the excellent clinician that can answer all of these questions... This is just minimal competence.