Sodium Bicarb.

[emtbill]

Neither can respiratory acidosis either yet we try to tx it.

How useful/accurate is sidestream capnography for determining respiratory acidosis? Even if it was useful I don't see myself giving bicarb for a presumed acidemia stemming from a respiratory problem. Oxygen seems like a better intervention.

 

[Ridryder911]

Remember, Oxygen is the first line not the whole line treatment regime.

R/r 911

 

[Hastings]

Sodium Bicarb is responsible for every complete cardiac arrest recovery that I've had. On patients that are in cardiac arrest because they skipped dialysis (very common around here), it's a wonder drug. From Asystole to Sinus with a pulse almost instantly. Very selective use, but for that purpose, it's golden.

If you ever have a renal patient in cardiac arrest and the regular ACLS bit isn't working, push Sodium Bicarb and Calcium Chloride. Again, never seen it fail in that specific case.

 

[emtbill]

The normal stimulus to breathe is a high level of carbon dioxide. If one alkalizes the blood incorrectly when acidosis is not present the H2O+CO2<->H2CO3<->H+HCO3 equilibrium will become imbalanced and the patient may become apneic. How do you reconcile this with the inability to determine acidosis in the field? The only signs and symptoms of this I can think of would be hyperventilation, which may be the patient trying to blow off excess CO2 from acidemia, or it might just be an anxious dyspneic patient whose labs are normal. Either way, I think improving ventilation if necessary with positive pressure and oxygenation with bronchodilators and supplemental oxygen would be a better treatment. Am I just wrong here? It's just that I was never taught to think about bicarb for respiratory distress, and the theory of its benefit in this situation seems shady for field use.