Date Published

October 26, 2023

Updated For

ALS PCS Version 5.2


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!


  • 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.


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


Additional Resources:

Recommendations for Nonvasopressor medications

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