The Pearls of Acid Base balance...Bicarb Therapy

First don't give Bicarb based on PH
Give Bicarb based on HCO3 level,if HCO3 <5

If HCO3 < 5 ,give 1 or two vials..enough and reasses the ABGs

If you found the PCO2 > 1.5 (HCO3) + 8,then ventilate the patient ,don't give HCO3

As U notice there are a lot of Don'ts ....yes don't use BICARB liberally ,Bicarb has its own risks:

Risk One:

Bicarb when adminstered it will release the CO2 Molecules that it holds -(HCO3...did use ce the CO2)-into the circulation ,which diffuse intracelluraly causing significant intracellular acidosis.

Risk two:

Bicarb ,it is Sodium bicarb...yes there is sodium,the questio is How much sodium?

1L of 0.9% NSS contains 154 Meq of Sodium
1L of NaBicarb,contains 1000 Meq of sodium,thus the the 50 cc ampule contains 50 Meq..which is 1/3 the amount of sodium in 1L of NSS....
This huge amount of Sodium may cause uninetntional increase in sodium levels causing hypernatremia and then fluid overload...
This High sodium content could be benificial in cases of brain edema and can be used as hyperosmolar therapy,imagine.

Risk three:
excessive use of Bicarb causes HYPOKALEMIA....

Comments

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

sedationstation

Search This Blog