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interesting thread on the caribbean forum about the future of anesthesia.
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absolutely won't happen..
have you seen the matching statistics even from 2002 until now for matching anesthesiology? it's gotten 20% harder each year for a foreign grad to match, for the 09' match , barely any IMG's matched gas.
if health care reform happens - the axe will fall on everyone. if anesthesiologists get paycuts, so will CRNA's, family docs, radiologists , etc.
in the 90's' my dad couldn't find a job paying more than 100k. that isn't going to happen again - especially in a system where crna's are pulling in almost 200k / year.
medicine does work in cycles - so many predict that history will repeat itself. people don't factor in the distaste med students have towards family and internal med nowadays, and the huge medical school graduating classes full of people gunning for rads and anesthesia - many more applicants make for more competition as well.
i can promise u gas programs are rarely going to go unfilled. and carribbean students going into Rads or gas? spare me.
if health reform screws our salaries or reimbursements more than it is now, we may see paycuts from the average 280-320k/ year down into the 250 range, but once again, if md salaries dip like that - crna's will be less and less appealing.
have you seen the matching statistics even from 2002 until now for matching anesthesiology? it's gotten 20% harder each year for a foreign grad to match, for the 09' match , barely any IMG's matched gas.
if health care reform happens - the axe will fall on everyone. if anesthesiologists get paycuts, so will CRNA's, family docs, radiologists , etc.
in the 90's' my dad couldn't find a job paying more than 100k. that isn't going to happen again - especially in a system where crna's are pulling in almost 200k / year.
medicine does work in cycles - so many predict that history will repeat itself. people don't factor in the distaste med students have towards family and internal med nowadays, and the huge medical school graduating classes full of people gunning for rads and anesthesia - many more applicants make for more competition as well.
i can promise u gas programs are rarely going to go unfilled. and carribbean students going into Rads or gas? spare me.
if health reform screws our salaries or reimbursements more than it is now, we may see paycuts from the average 280-320k/ year down into the 250 range, but once again, if md salaries dip like that - crna's will be less and less appealing.
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There is no way the demand for Anesthesia will diminish in the near future, even if salaries fall to bellow 200K, people are still going to choose Anesthesia over IM because it offers a better lifestyle. In the long term, for example 20 years, a lot of things could change in terms of demand, but in the short term nothing will change, if anything there will be more demand.
Well.... I think we would see a surge in ER apps... they work 36-40 hrs a week (3-4 shifts), no pager, and earn almost as much as anesthesiologist do. I think it's important for people to do what they really LOVE doing. I couldn't do anything else besides anesthesiology... well maybe snowboard for the rest of my life, but my knees are already starting to get blown out
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for the most part, ER has gotten more competitive. the step 1 scores to match it are very close to gas.
in rural markets ER docs are compensated similarly as anesthesiologists, but in urban markets not so much. in chicago it's pretty common for an anesthesiologist to average 300k+ / year. ER doc averages are closer to 225-240k. they work 36-40 hours ,but those 36 hours are hellish, and are at all times of the day and night.
there's a definite ceiling with compensation in ER medicine that is lower than anesthesia. if there's an overlap, its the higher earning er docs making as much as the lower earning gas docs.
i will say this much though - ER medicine is much more secure from encroachment by midlevels and paycuts. it's always been a mid road specialty - paying better than IM or FP and not as well as 'ROAD'. it will probably continue to be that way .
in rural markets ER docs are compensated similarly as anesthesiologists, but in urban markets not so much. in chicago it's pretty common for an anesthesiologist to average 300k+ / year. ER doc averages are closer to 225-240k. they work 36-40 hours ,but those 36 hours are hellish, and are at all times of the day and night.
there's a definite ceiling with compensation in ER medicine that is lower than anesthesia. if there's an overlap, its the higher earning er docs making as much as the lower earning gas docs.
i will say this much though - ER medicine is much more secure from encroachment by midlevels and paycuts. it's always been a mid road specialty - paying better than IM or FP and not as well as 'ROAD'. it will probably continue to be that way .
Critical Care Nurse Practitioners already see patients in the ER in my home state. Their role at this point is limited to less complex cases but they actively complain about this limited role and having to have the attending MD sign off on their management. I absolutely see them taking the next step and lobbying for the rights both within my hospital and within my state as a whole to see patients without MD supervision/oversight. I believe such an idea will catch on first in underserved areas of the state where Emergency physicians are lacking in #, then later in the more populated areas. It seems inevitable that the Critical Care Nurse practitioners will encroach on the ER and ICUs much like CRNAs did in the OR. Just my thoughts.
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thats unfortunate, i didn't know critical care nurses to encroach in that manner? at our hospitals they are more involved in relieving the EM guys from the easier stuff.
it just doesnt seem likely.. i figured FP's and IM's looking for some extra dough were the ones that filled the spots in rural hospitals without EM guys.
in the future the AMA and EM lobby will just have to make sure to not loose ground. once again , everyone thought CRNA's were going to be the end of the world for anesthesiologists about 10 years ago, and that didn't happen.. what the future holds isn't for certain..but once again, if the critical care nurses push for more work/rights, they will want more $$. EM docs are already often working for 200k, so it might not be as economically threatening as CRNA's were to anesthesiologists. ( ie , they used to work for 90-100k vs 300+ for anesthesiologists. that gap is now closing as crna's commonly earn 200k for a 40-50 hour work week...)
it just doesnt seem likely.. i figured FP's and IM's looking for some extra dough were the ones that filled the spots in rural hospitals without EM guys.
in the future the AMA and EM lobby will just have to make sure to not loose ground. once again , everyone thought CRNA's were going to be the end of the world for anesthesiologists about 10 years ago, and that didn't happen.. what the future holds isn't for certain..but once again, if the critical care nurses push for more work/rights, they will want more $$. EM docs are already often working for 200k, so it might not be as economically threatening as CRNA's were to anesthesiologists. ( ie , they used to work for 90-100k vs 300+ for anesthesiologists. that gap is now closing as crna's commonly earn 200k for a 40-50 hour work week...)
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and one more thing to point out....
i dont mind CRNA's or critical care nurses working and helping in areas where there are no doctors or no physicians are willing to go. but it's less and less and less likely that they will be able to encroach in urban areas..why? because there are barely any decent paying jobs for EM docs or anesthesiologists in urban areas. Physicians are paid 20-50% less in these big cities as is, nurses don't have the "money saver" appeal that they do in the farmland - there are also plenty of docs working in cities so there isn't a 'shortage', ie, an excuse for nurses to take over these jobs.
just my .02, based on what i've seen here in chi, ny and la. crna's have their run of the show in wisconsin and indiana ( in small towns ), but in chicago there are so many damn anesthesiologists willing to work for decent money that the feared 'crna takeover' never materialized here.
yet.
i dont mind CRNA's or critical care nurses working and helping in areas where there are no doctors or no physicians are willing to go. but it's less and less and less likely that they will be able to encroach in urban areas..why? because there are barely any decent paying jobs for EM docs or anesthesiologists in urban areas. Physicians are paid 20-50% less in these big cities as is, nurses don't have the "money saver" appeal that they do in the farmland - there are also plenty of docs working in cities so there isn't a 'shortage', ie, an excuse for nurses to take over these jobs.
just my .02, based on what i've seen here in chi, ny and la. crna's have their run of the show in wisconsin and indiana ( in small towns ), but in chicago there are so many damn anesthesiologists willing to work for decent money that the feared 'crna takeover' never materialized here.
yet.
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You have keep something else in mind. An ED physician or in this case critical care NP's can't simply admit a pt unless someone else on the other side accepts the pt. If the hospitalist or internist refuses to take the pt from the NP's because they don't trust their judgment, then NP's won't make much headway. I can see this happening after getting a few bogus admissions from a nurse. Seeing newly admitted pts is more work for the hospitalist/internist and they will simply get pissed off if they have to see pts who should never have been admitted in the first place. I know I would.
There's a big difference between the wards/ED vs. the OR. CRNA's learn routines and procedures that they apply repetitively in the OR more or less the same way for each pt. There is no such routines on the wards/ED. You have to know your medicine in those places. You can't expect to learn all the medicine you need to know in 2 years.
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You're fooling yourself if you think Gas has a better lifestyle than IM. It does if you work part time. Outside of that, it is a similar amount of hours worked compared to IM except Gas gets up earlier. But of course, Gas $$ >> IM $$ on average.
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I would agree that on average gas makes more than IM. However, I will say that on a rotation at a private hospital last month, the IM hospitalists (who work 1 week on typically until 9pm each day and then 1 week completely off... 26 weeks off a year!!) make $325,000. Crazy right??
That being said, I can't wait to be done with my prelim IM year... I... can't... take... it... anymore!!!.... (sorry, had to vent)
That being said, I can't wait to be done with my prelim IM year... I... can't... take... it... anymore!!!.... (sorry, had to vent)
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that doesn't add up...in chicago at some of the higher paying private hospitals, the hospitalists are making ~ 200k for 1 week on / 1 week off. my cousin works out in rockford and makes about 220. the docs that pull in 325 are usually doing the 1 week on and doing extra shifts in the week off, from what i've seen. it's unlikely, i think, to make 325 just from 1 week on/off until 9. ( unless they're doing like 14-16 hour shifts? )
however, hospitalists make great bank. a lot of GI's, cards, pulm, and other IM specialists are at the hospital till 6 or 7 anyways, and they make 350-400 without an extra week off. even if hospitalists work in a couple extra days on their week off, they can pull in 300 easily.
it's a great job - don't know how long it will stay this popular for this much $$, at some of the chicago hospitals a few of the nephrology guys are already cutting out the IM's without fellowships for the hospitalist shifts.
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i agree 100%. the ER is a hectic and high stress environment that requires a lot of fast judgment and knowledge. for the bread and butter stuff, sure, a critical care nurse can handle it. however, the ER is one place you get all kinda of random stuff coming in the door and thats when medical school + residency knowledge comes in play.
i'm not saying specialized nurses are chopped liver, they are good at what they do - but they're not as educated as a physician, they are more of a technician than a thinker. this is why they are so easily rallying against anesthesiologists - the majority of the cases with anesthesia are the same thing over and over a gain, a technical job that a nurse can master if they want to...of course when the complicated cases come in or when **** hits the fan, we need an MD - but this doesn't happen super often. however, this is irrelevant. when someone's life hangs in the balance, you need someone who knows everything that's going on - not just a skilled technician. you can train a high schooler to do surgery if it's the same case over and over again - but you still wouldn't want them doing your valve replacement.
in any case, nobody (*that matters ) buys that a nurse can do a physicans job, period. crna's, critical care nurse, dnps, whatever- they are here to help take the load off the MD's shoulders when they can't be there or are busy doing something else. it's when lazy MD's let the midlevels do all the work we start having problems. this lazy md mentality is getting rarer and rarer as these specialties get more and more competitive. hopefully this makes for a brighter future.
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You can make a lot as a hospitalist these days. I personally am a graduating IM resident who is still trying to figure out what I am doing with my life. I will probably go onto a fellowship but in the meantime I took a job with a high powered academic center as a hospitalist for connections and research potential. My job characteristics?
Well I will be making 170-180k working 10 hour shifts (9-7 or 7-5) with 3/nights a month spliced in. The first year I will be working weekends about half of the weeks I'm on, then it moves to 1 weekend/month thereafter.
No clinic, no critical care, no required procedures, with an NP to be my resident for half of the patients, secretaries who get all records, and nothing to follow up after I leave the hospital. The kicker? I have 5-6 months off. Two of the off weeks I have to leave my pager on to backup anyone who becomes sick, but outside of that I have zero responsibility for the remaining time.
That is at a high powered academic center that usually pays nothing to low ranking docs. You can make a lot lot more in the community, obviously.
But, if you hate IM, it doesn't matter what the job characteristics are, you can't do it.
That being said, Gas usually makes $$$$ >>>> IM.
My point is that the lifestyle argument is not really true. Most of the outpatient IM clinic docs at my univerisity work 8-5:30 with no call or weekends. That's it. In the community docs work their ass off to earn more money, but they don't have to.
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I'd rather push a rock up a hill for all eternity than endure one 15 minute clinic appointment after another.
Yeah, I couldn't do it. But I'm so grateful that there are people who can. 🙂
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325K for hospitalist is very unusual. The mgma mean for hospitalists is 170K.
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every specialty has its basic bread and butter stuff.
you HAVE to know your medicine and critical care and procedures and technology in the OR just as on the wards - but, realistically, in a large percentage of cases that expertise may not be necessary both in the OR or in ED/wards.
here's THE issue: you don't know in which cases you will need to apply higher level management and in which you won't. that's why it is important to have an physician at the junction of triage - to direct the midlevels. once the physician decides that the case is routine, the midlevels can take over and run their protocols. in my opinion, the most educated person should make those critical "triage" decisions - that's just common sense. having said this, no one can be spot on all the time - so continued participation and availability of highest caliber clinicians is vital.
don't care what anyone says, i want my medical decisions to be made by experienced PHYSICIANS. midlevels/nurses have their very important roles, but the ARE NOT suited for critical clinical decision making (as i have seen over and over). just like i want the plane to be handled by experienced well trained pilots, not by pilot assistants who took the abbreviated version of the curriculum. not interested in being the subject of the study to find out if "it makes any difference."
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Good god... my Mom was a nurse so I have the highest respect for nurses, but seriously, I'm so sick of the critical care nurses trying to encroach on everything... first anesthesia, now ER! WTF... it's got to stop sometime. EVERYONE wants to be a doctor without going to medical school and residency. They just want to skip the rigorous 8 years that we slaved away at so they can have great pay and be able to be INDEPENDENT. I'm so sick of it... physicians need to start lobbying against nurses trying to be doctors. 😱
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tracheatoedoc is obvious very smart and has had a lot of great posts...but I've got to disagree with this one.
I don't see med students flocking to primary care again any time soon. At the most, if we have health care reform that tries to entice and/or force more people into primary care, at the least I think you might see medicine residents opting out of fellowships like endocrine and rheumatology. However, for the fellowships that are more interesting (like cardiology) and/or pay more (GI, cards, hem/onc) you will still see residents going into those areas.
I think if there is continued pressure for cost savings by the government, it will affect all specialties. Primary care is a crappy lifestyle in many cases, particularlyif one is working in a rural location with little or no backup. The hours are often NOT good, despite what is being posted on this board. The hours of a typical internist on the faculty at a tony private hospital with a great residency program do not reflect the typical lifestyle or hours of a fp or IM doc in the community...they are getting buried in paperwork, often unappreciative patients and unappreciative subspecialist colleagues. It is NOT a great job, IMHO. I would have opted to be a hospitalist if I couldn't have done cardiology...not sure what I would have done if my options were primary care or no medicine. I guess I would have done it, but it would have been painful. Primary care is one of those things that sounds good when you are premed, but when you see/experience what they actually do, it kind of sucks in most cases. They also have little job security is many policy makers and a good part of the general public, as well as the nursing lobby, thinks that primary care is rather easy and that midlevels can do the primary care docs job well.
Unless there are super-radical changes in reimbursements, radiology and anesthesia will continue to be more popular than fp or IM. Both of them have a better lifestyle, better hours and more money than primary care. They also lack the heavy, in-your-face patient care than can create a lot of stress in cases where patients or families are, for lack of a better word, nuts...
I don't see med students flocking to primary care again any time soon. At the most, if we have health care reform that tries to entice and/or force more people into primary care, at the least I think you might see medicine residents opting out of fellowships like endocrine and rheumatology. However, for the fellowships that are more interesting (like cardiology) and/or pay more (GI, cards, hem/onc) you will still see residents going into those areas.
I think if there is continued pressure for cost savings by the government, it will affect all specialties. Primary care is a crappy lifestyle in many cases, particularlyif one is working in a rural location with little or no backup. The hours are often NOT good, despite what is being posted on this board. The hours of a typical internist on the faculty at a tony private hospital with a great residency program do not reflect the typical lifestyle or hours of a fp or IM doc in the community...they are getting buried in paperwork, often unappreciative patients and unappreciative subspecialist colleagues. It is NOT a great job, IMHO. I would have opted to be a hospitalist if I couldn't have done cardiology...not sure what I would have done if my options were primary care or no medicine. I guess I would have done it, but it would have been painful. Primary care is one of those things that sounds good when you are premed, but when you see/experience what they actually do, it kind of sucks in most cases. They also have little job security is many policy makers and a good part of the general public, as well as the nursing lobby, thinks that primary care is rather easy and that midlevels can do the primary care docs job well.
Unless there are super-radical changes in reimbursements, radiology and anesthesia will continue to be more popular than fp or IM. Both of them have a better lifestyle, better hours and more money than primary care. They also lack the heavy, in-your-face patient care than can create a lot of stress in cases where patients or families are, for lack of a better word, nuts...
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Can we please stop the talk about nurses taking over for ER docs, its just not gonna happen, end of story. They are just not qualified whether they are ER nurses or critical care nurses. It won't happen and it just can't. There will always be a doc there as the last line of defense. Sure midlevels will see pts under the supervision of a physician or they may run the urgent care side of the ER where the ER doc is 15 feet away in case they run into any problems but they will NEVER be running and ED all by themselves w/out physician supervision. It's just too complicated is just not going to happen. No disrespect to nursing staff, it requires a 4 year medical school education and a 3-4 year residency to run an ED. Period end of story.
Now lets get back to everyones favorite game, forecasting the end of the world and how we as anesthesiologists will be working for peanuts or out of a job
Now lets get back to everyones favorite game, forecasting the end of the world and how we as anesthesiologists will be working for peanuts or out of a job
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This can truly be said of almost anything in medicine, and not just ED/wards or the OR. Could be any of the medical sub-specialties, derm, and most surgical specialties.
Otherwise, I agree with the rest of your post.
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There is an exception to any rule. The avg midlevel couldn't do it just like the avg CRNA could not work solo
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Friend, I have worked with average CRNA's who also work solo out in no mans land.
Stated differently: there are sub-average CRNA's at sub-average locations of the country, providing really sucky, sub-average care to really sub-average IQ patients, cared for by sub-average surgeons, who work for sub-average administrations/hospitals. Like they say: it's the law of (sub)-averages.😉
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I couldn't have said it any better myself
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Arch Guillotti
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I don't like the mid-level creep any more than anyone else on this forum. The stark reality is that the creep continues, and is widespread. To claim that midlevels will "never" gain certain rights (when they already have in some instances) is turning a blind eye to the sad direction that medicine is taking.
Donate to the ASAPAC.
Donate to the ASAPAC.
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Amen to that ...
There's even an option to automatically bill a credit card every month. Small amounts add up. Anyone can afford a few bucks per month.
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What I have found working with CRNAs is that they generally can not aswer questions on concepts understood by 95% of 4th year med students. Their knowledge of anesthesia is superficial because it is basically dosesof meds, airway maagement.
Anesthesia is the practice of medicine. To be a good anesthesiologist one needs to know critical care and the medical impications.
A couple of months ago I had a discussion with a CRNA about the relationship between pH and K+ ions. It freaked me out that he did not understand this, as it was the most crtical aspect of the respective case.
Again, anesthesiology is the practice of medicine.
The original post was my anticipation that in a tight job market people will not go into Gas. It happened in the mid 90's, many of you remember. I have met more than 1 person from that time who fnished Gas and went into ER for a job, and stayed there.
I do think that interest in doing Gas is ready to wane and residency will be much easier to obtain.
Anesthesia is the practice of medicine. To be a good anesthesiologist one needs to know critical care and the medical impications.
A couple of months ago I had a discussion with a CRNA about the relationship between pH and K+ ions. It freaked me out that he did not understand this, as it was the most crtical aspect of the respective case.
Again, anesthesiology is the practice of medicine.
The original post was my anticipation that in a tight job market people will not go into Gas. It happened in the mid 90's, many of you remember. I have met more than 1 person from that time who fnished Gas and went into ER for a job, and stayed there.
I do think that interest in doing Gas is ready to wane and residency will be much easier to obtain.
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In the state where I now practice (due to SDN politics, I won't tell you), PAs and NPs are in curious positions. PAs can prescribed up to CIII, but CII needs my cosignature. However, they can't sign their charts independently. I have to cosign all of the charts, and this gives me leverage for one of the meatheads (we can't can him until we find another PA). However, NPs, who are reportable to the Board of Nursing, not Board of Medicine, can hang their own shingle, and their charts don't have to be cosigned - but they can't get DEA numbers (because they're BON instead of BOM). This has become a sticking point, because of "personal pride" that they won't ask me to stop in and look at the patient for 30 seconds or one minute, so they can put a blurb in the chart of "pt seen and examined with attending", and they can write for Vicodin. Interestingly, the medical direction for the NPs comes from primary care, and those folks have refused to give them pre-signed scripts to use. So, when your medical director won't do it, who's left? Of course! The EM doc! Just like when your pain medicine doc won't refill your Percocet or Oxycontin early, sure, come to me! I LOVE writing you for the bridge, expressly in violation of your contract with pain management!
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At the risk of looking like a total chump, does an increase in potassium decrease the pH of a patient and put them at risk for acidosis?
My thinking:
More K+ leads to the reaction: K+ + OH- -> KOH
This leads to less OH- which means:
H2O -> H+ + OH-
pH = -log[H+] which means as H+ rises, pH drops.
This kinda jumps over the whole carbonic acid/bicarbonate idea, but that's the mostly intermediary stuff anyhow.
How'd I do?
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Acute changes in blood K+ are almost universally due to something that has triggered a shift between the intracellular and extracellular/intravascular spaces. pH affects the concentration of K+, as K generally follows H. In the absence of other factors, alkalosis (high pH, low H+) results in intracellular K+ shift, and acidosis (low pH, high H+) results in extracellular K+ shift.
The type of acidosis or alkalosis matters to some degree. A gap acidosis generally isn't associated with an increased K, and you'll get more hypokalemia with a metabolic alkalosis than with a respiratory alkalosis.
Insulin and beta agonists also move K into cells.
Sometimes these factors interact, the classic example being diabetic ketoacidosis.
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Like pgg stated, it's generally from transcellular shifts in the respective ions.
While pH is a measurement of extracellular fluid (i.e. serum), to help you remember, you can think of it in the following way;
Low pH/high H+ (i.e. acidosis) causes more protons to enter a cell, from serum where H+ was high. To balance the charge, K+ will leave the cell and enter serum. Hence, metabolic acidosis being associated with hyperkalemia.
When thinking of the reverse case, of alkalosis (say metabolic) where a patient is losing H+ from vomiting for example, think of what happens from the perspective of the RENAL tubular cell. That is, they will try to reabsorb more H+ from the filtrate. Thus, driving more H+ into the blood to compensate, and with a subsequent shift of K+ INTO the cell (once again, to balance the intracellular charge). Hence metabolic alkalosis being associated with hypokalemia.
Again, these are mainly ways to help you remember without getting too crazy into renal physiology, which can indeed be complicated.
To further elaborate on DKA, remember that because of the osmotic diuresis that occurs, a patient may actually have LOW potassium stores (the diuresis doesn't leave "time" to get reabsorbed. BUT, because of the LOW insulin (again, insulin drives K+ into the cell), K+ labs may look high, but this is called pseudohyperkalemia (in lieu of likely total body potassium stores being actually low). Again, as pgg eluded to, you may need to GIVE a DKA pt K+ supplementation (but only when they are making urine since the rate of PO absorption of K+ can never surpass the ability of the kidney to excrete excess (in non-renally impaired pts), thus avoiding hyperkalemia from K+ replacement which is refered to as "iatrogenic", meaning "we did it".....lol)
Hope this helps, but seeing that you're a pre-med, you'll get much more repetition on this stuff as you advance in your profession.
cf
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Hope no one thought that I was being ungracious with my reply as the above was meant as a joke.
To pgg and cfdavid, I appreciate the explanations. I was thinking in terms of giving or not giving K+ to help affect blood pH, so I was thinking about it the wrong way.
It seems clear from the explanations that K+ is correlated to blood pH as opposed to something that changes it. So, at the risk of asking a question that I should just wait 2 years to learn the answer to, why can you not just directly check blood pH instead of using a surrogate in K+?
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The only reason K+ may be used as a surrogate is the situation where you also see low HCO3- with, say, an anion gap along with a clinical suspicion of anion gap metabolic acidosis. Technically, you need a blood gas, however, to diagnose an acid/base disorder.
The most common causes of LOW K+ are from thiazide and loop diuretics and GI losses.
Blood chemistry's (gives ions and other things but not pH), versus blood gases (which yield an actual pH) are much more commonly drawn.
You should just hang tight until med school, since you'll get this in the wards.
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My mistake, misunderstood your question. Administering K+ isn't going to measurably affect pH.
Also, K+ levels change very, very slowly. IV administration of KCl is slow (generally no more than 0.5 mEq/kg/hour) and the vascular space is a TINY portion of total body K. Most of the K you administer IV redistributes out of the vascular space quickly and serum [K+] changes very, very slowly.
You can and we do. As cfdavid said, K is a lousy surrogate for pH and I don't think I've ever seen it used that way. If you get a regular chemistry panel from a venous blood sample in a sick patient, values like low HCO3, high lactate, or an anion gap (Na - Cl - HCO3 > 12) can clue you in that an acidosis is probably present, but K usually doesn't come into the picture.
Venous blood samples aren't often tested for pH unless they come from a central line, and those have some limitations. pH measurements are generally more useful from arterial blood samples, which are easy enough to get, but require an arterial stick or the presence of an indwelling arterial catheter. You've got a dozen+ spots on your arm for a venous draw, but only one radial artery, so arterial draws aren't done just for the hell of it.
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like they said above you don't use K+ to determine the pH of the blood, but you need to know what happens in certain situations because K+ affects the electrical activity of the heart and you don't want to start correcting K+ when a patient has pH abnormalities because you might be correcting a false number, instead you want to correct the pH abnormality which will correct the K+.... like CfDavid said just wait till med school you'll learn all this in physiology in your first year of med school.
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Sweet. Thanks to all for the clinical info. As cf suggests, maybe I'll leave the clinical stuff to the big boys for a year or two. But I definitely appreciated the explanations.
i agree. this is kind of ridiculous
they have MD's COMPLETING three fudging years of internal medicine residency
and then TWO of emergency fellowship
and lots of COMPLETED family doctors who have completed urgent care fellowships ON TOP OF THIER original residencies
and they can only get certified by 1 of the 2 boards
for god sakes, if there's a void, let these guys fill it, who compete for jobs, not the nurses
they have MD's COMPLETING three fudging years of internal medicine residency
and then TWO of emergency fellowship
and lots of COMPLETED family doctors who have completed urgent care fellowships ON TOP OF THIER original residencies
and they can only get certified by 1 of the 2 boards
for god sakes, if there's a void, let these guys fill it, who compete for jobs, not the nurses
