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Technology: friend and foe.

Recently, I was making a small purchase of stickers for my 11 year old. The cashier rang it up to be $1.36. I handed her a twenty dollar bill. As her cash register flashed the amount of change I was due--$18.64--I dipped into my wallet for the odd penny. As I handed her the penny she looked stunned. I instantly recognized her confusion and muttered, "$18.65". "Thanks!" she breathed in relief.

Now I turn to a mental recollection of my 8 year old learning to make change for a math assignment. Yes, we still teach children how to calculate. But does the technology make us lazy? Do our mental calculating muscles become atrophied as we integrate technology into our every day lives?

I think we're safe as long as we keep our perspective. It's not the process of calculating that is important, but rather what we do with the data we produce. Calculators free us up to perform the task of greater importance; interpreting and applying data.

Relying on technology can be flawed. Flaws are the result of "human error". You can have the fanciest calculator in the world; the human operator is the key to a successful outcome. Garbage in, garbage out. The operator must ensure that the data going in AND the data coming out is valid.

In Respiratory Care we went from being mechanics of unique machinery (remember hot pots and plumbing clamps?) to software operators with sophisticated microprocessors. The human being integrates the ventilator with the patient. The technology provides us, the clinician, with a greater amount of data. We must validate and apply that data to the clinical situation of our patient.

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Let's look at sources on the Internet for medical calculators. I searched on-line to see what the tech geeks had come up with as far as calculators. Respiratory Care is fraught with calculations, from tanks, to blood gases, to hemodynamics.

If you search for "medical calculators" you will get most of the better sites to come up. I've chosen some of the better sites and will list them here with a quick description. Educators and students will love these. Patient educators as well will like some of the "score" calculators. Technology can only produce good result with good input. Therefore, all of these sites display a disclaimer. Before relying on a calculator that is new to you, verify that the results it is producing are accurate. Example Disclaimer: "All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses/values are not a substitute for clinical judgment."

Tucows & Freeware Palm -- If you have a palm pilot and would like to try some fun and handy freeware/shareware like the "ABG Decoder" that I mentioned I would recommend visiting www.tucows.com. They have a tank calculator, dosage calculators, BMI calculator and others, including the "MD ABG" designed to do everything from simple single acid/base disorders to the complex triple acid/base nightmares.

Another program that includes 82 calculations, pulmonary and cardiac included, is at the following link: www.freewarepalm.com/medical/icumath.shtml

Pediatric Critical Care Medicine at Cornell University has conversion calculators, respiratory calculators and metabolic calculators (as well as dosage calculators). I like these because they also give a narrative explanation to help interpret results and they show the actual calculation formula used by the calculator. For example, here is the explanation for A-a gradient: "High gradients result from impaired diffusion or, more commonly, by ventilation-perfusion inequality of the "shunting" variety. A normal A-a gradient is less than 10 torr. The age (years) / 4 + 4 is another conservative estimate of a normal gradient. The calculations assume 100% humidity at sea level and a respiratory quotient of 0.8, using the alveolar gas equation to determine PAO2: PAO2 = (FiO2 * (760 - 47)) - (PaCO2 / 0.8) A-a gradient = PAO2 - PaO2 http://www-users.med.cornell.edu/~spon/picu/calc/medcalc.htm

Internal Medicine at Medical College of Wisconsin has a small list of calculators. Some of the cardiac calculators have an explanation. The calculators are: A-a Gradient, Anion Gap, BSA/BMI, Estimated creatinine clearance, Fractional Excretion of Sodium, Heart Disease Risk, LDL Cholesterol Goal Level, Ingested Substance Blood Level, Serum Osmolality, Temperature Conversion (F-C). http://www.intmed.mcw.edu/clincalc.html

MediCalc 3000 is a commercial site and will only provide you with a sampling of calculators for free. You must pay for the rest. Once at the site click on "Search by Specialty" and you will be taken to the list of calculators. They have some that are different than the standard calculators like "Pneumothorax Degree of Collapse" for example. http://medcalc3000.com/

MedStudents.com is a site designed by Richard Toptani, an Internal Medicine Resident at Iowa University. There are alot of hemodynamic formulas. Each calculator includes the formula. http://www.medstudents.com.br/calculat/index2.htm

The Reference Desk has calculators/simulators useful for students. www.martindalecenter.com/Calculators1B_3_MedPZ.html

PedsCCM -- The Pediatric Critical Care site includes pulmonary calculators for chest wall and dynamic/static compliance. www.pedsccm.wustl.edu/all-net/english/javascript/javascript.htm

AHRQ -- Agency for Healthcare Research and Quality--I liked the pneumonia severity index calculator at this site. This is a direct link to the calculator. http://pda.ahrq.gov/clinic/psi/psicalc.asp

EMedicine.com has calculators but also "scores" for things like croup. www.emedicine.com/splash/shared/etools/index.htm

Recently, I was discussing a blood gas result with one of my coworkers. I thought we might calculate the A-a gradient. As I reached w-a-a-a-y back in my brain to drag out the Henderson-Hasselbach equation, I goaded my coworker, "FIO2 times barometric pressure minus......" He rolled his eyes but once my calculation was complete we discussed what might be causing this huge A-a gradient in our ventilated patient. My coworker is a great example of what really counts in a therapist. Recalling rote formulas is not what's important, rather it's being able to understand and apply the information to better serve the patient. Technology keeps adding clinical tools to our arsenal. Let's use them.

by Lisa Rapple M.Ed RRT
COPYRIGHT 2004 Focus Publications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2004 Gale, Cengage Learning. All rights reserved.

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Title Annotation:RESPIRATORY CARE ON-LINE
Author:Rapple, Lisa
Publication:FOCUS: Journal for Respiratory Care & Sleep Medicine
Geographic Code:1USA
Date:Mar 22, 2004
Words:1036
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