Sodium bicarbonate after cardiac arrest?

It used to be taught in versions of ACLS long past, the sodium bicarbonate should be administered as part of ACLS for the treatment of cardiac arrest. This is no longer the practice, but why? The principle academic answer is that there has not been any demonstrable improvement in outcomes. The practical explantation is that in an arrest situation, if an acidosis is present it is most likely from a respiratory cause--- respiratory acidosis. Therefore, the appropriate treatment would be to support the airway and provide mechanical ventilation.

How does acidosis affect pharmacology

Drugs interact wit various tissues through receptors. The interaction of a drug and a receptor are a complex relationship like a lock and key. A lock and key have a complex three dimension structure, and if the structure of either the lock or key change, then they are not capable of interacting.

When a person is in shock they have may have a low blood pH or acidosis. Acidosis causes the structure of the receptors to change shape. When the shape of a lock changes, then a key will not work. This is the problem often with acidosis. When a person has a low plasma pH, some drugs will not be able to bind with receptors and produce the desired physiological response. This is a problem, because if you administer an adrenergic drug like norepinephrine (Levophed) to an acidotic patient you will not see the desired response of an increase in blood pressure.

Norepinephrine (Levophed) is an adreneric agent used to increase blood pressure. It binds with adrenergic receptors.

Negligence

Administration of medications can be dangerous and result in injury to a patient. You need to know the four elements of negligence and what are those definitions. Listen to the latest podcast at www.prehospitalpharmacology.com

Welcome.  This is a blog that will serve as a companion to one of my textbook, "Pharmacology for the Prehospital Professional."   This is a book that is published and will be scheduled for release in February 2009.   

I am of the opinion that pharmacology is a hard topic to learn.   So many names that are hard to remember and so many difficult thing to remember.   I doesn't need to be so hard for the student or experienced paramedic.   I spent a great deal of effort to try to make this topic understandable for everyone.  We have also set up a podcast that is available for download. With the podcast, I provide a 15 minute lecture that is free to download.  This way you can study your pharmacology while driving, exercising, or working in the yard.

With this blog, I hope to connect the students and the author.  This way we can have a really real time discussion regarding topics and questions that you might have regarding prehospital drug therapy.