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:
- Special situations of cardiac arrest:
- Known or suspected hyperkalemia
- Other causes of acidosis (a separate post on this, later!)
- 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!
- 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
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.
Check out SWORBHP’s podcast on Bicarb administration from Dec. 15th, 2020