Sodium Bicarbonate 50 mEq/50 mL is mandated to be carried by ACPs per the Equipment Standards, however, it is not written into the Treatments sections of the ALS-PCS. ​

​Therefore, administering sodium bicarbonate is outside the scope of the Medical Directives and requires a patch to the Base Hospital Physician.​

​Let’s briefly review Bicarb and when to consider patching for it!

 

AHA (2020) Recommendations:

The AHA Guidelines for CPR and ECC (2020) suggest evidence for use of sodium bicarbonate in the following:​

1. Special situations of cardiac arrest:
   • Known or suspected hyperkalemia 
   • Other causes of acidosis (a separate post on this, later!) ​
2. Cardiac conduction delays due to sodium channel blocker or tricyclic antidepressant (TCA) overdose:
   • Signs include widened QRS on ECG
   • The patient does not need to be in cardiac arrest!

Background​

• Alkalinzing agent; Electrolyte supplement​
• Ongoing debate regarding potential benefit vs. harm in cardiac arrest management​
• Frequency of use varies greatly between medical centers and between clinicians​
• Administration is advised at the discretion of the physician directing the resuscitation

AHA (2020) Recommendations cont’d:​

No evidence for use in routine, undifferentiated cardiac arrest:​

• AHA recommends against sodium bicarbonate in this case​
• There is no evidence for improved outcomes​
• Evidence suggests it may worsen survival and neurological recovery

Bottom Line

Consideration for the administration of sodium bicarbonate is multifactorial – a BHP Patch is required to administer. ​

​Consider patching for the evidence-supported times to administer sodium bicarbonate! ​

​Interested in more information? Stay tuned for part 2 of this tip with more in-depth information.​​

AND​

Check out SWORBHP’s podcast on Bicarb administration from Dec. 15th, 2020