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ACLS Algorithm,Sodium Bicarbonate



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Sodium Bicarbonate.
Sodium Bicarbonate Tissue acidosis and resulting acidemia during cardiac arrest and resuscitation are dynamic processes resulting from no blood flow during arrest and low blood flow during CPR .

These processes are affected by the duration of cardiac arrest, level of blood flow, and arterial oxygen content during CPR.

Restoration of oxygen content with appropriate ventilation with oxygen, support of some tissue perfusion and some cardiac output with high-quality chest compressions , then rapid ROSC are the mainstays of restoring acid-base balance during cardiac arrest.

Two studies demonstrated increased ROSC, hospital admission, and survival to hospital discharge associated with use of bicarbonate.
However, the majority of studies showed no benefit or found a relationship with poor outcome.
There are few data to support therapy with buffers during cardiac arrest.
There is no evidence that bicarbonate improves the likelihood of defibrillation or survival rates in animals with VF cardiac arrest.
A wide variety of adverse effects have been linked to administration of bicarbonate during cardiac arrest.

Bicarbonate may compromise CPP by reducing systemic vascular resistance.

It can create extracellular alkalosis that will shift the oxyhemoglobin saturation curve and inhibit oxygen release.

It can produce hypernatremia and therefore hyperosmolarity .

It produces excess CO2, which freely diffuses into myocardial and cerebral cells and may paradoxically contribute to intracellular acidosis .

It can exacerbate central venous acidosis and may inactivate simultaneously administered catecholamines.
In some special resuscitation situations, such as preexisting metabolic acidosis, hyperkalemia , or tricyclic antidepressant overdose, bicarbonate can be beneficial (see Part 12: Cardiac Arrest in Special Situations).

However, routine use of sodium bicarbonate is not recommended for patients in cardiac arrest (Class III, LOE B).

When bicarbonate is used for special situations, an initial dose of 1 mEq/kg is typical.

Whenever possible, bicarbonate therapy should be guided by the bicarbonate concentration or calculated base deficit obtained from blood gas analysis or laboratory measurement.

To minimize the risk of iatrogenically induced alkalosis, providers should not attempt complete correction of the calculated base deficit.

Other non CO2-generating buffers such as carbicarb, THAM, or tribonate have shown potential for minimizing some adverse effects of sodium bicarbonate, including CO2 generation, hyperosmolarity, hypernatremia, hypoglycemia, intracellular acidosis, myocardial acidosis, and overshoot alkalosis.
But clinical experience is greatly limited and outcome studies are lacking.

ACLS Algorithm DOCUMENT HOME

MSCscience.com

Stepping Up To Standards Compliance

Solution ----> Medical Standards Compliance Tools





Sponsor Links

Medical Standards Compliance Science
CPR ECC Web Site

    Medical Standards Compliance Science ,Tools For Training & Implementation
   
  2010,American Heart Association ,Guidelines for CPR and Emergency Cardiovascular Care (ECC).  
2010 ILCOR International Consensus on CPR & ECC    

Tools For Training & Implementation

  • Simulators

  • E Learning

  • Paper less charts (Electronic medical records -EMR )

  • Certification Exam Preparation