[poohbear1968]

What is the most importan treatment for a patient in cardio/respiratory arrest w/respiratory acidosis? Increase ventilation, decrease ventilation or increase FiO2.

[sharrie]

I take it you mean post arrest not during a cardiac arrest.

If you have an acidosis in cardiac arrest then you should be using the ALS guidelines for resuscitation ventilations and compressions.

If you mean post cardiac arrest then I would suggest that high flow oxygen should continue in the immediate period afterwards. Acidosis should improve if / when circulation is restored.

[deeDawntee]

Is this a practice question? If the patient is arresting, correcting the acidosis is not the priority, as the above poster said, follow ACLS guidelines....(airway,breathing, circulation etc)

If not arresting, I would say answer would be increase ventilation,

[poohbear1968]

Thanks,

Yes it is a practice question We are able to use any source to find the answer but I cant seem to find it anywhere! The question was:

The most important treatment for a patient in cardio-respiratory arrest with respiratory acidosis is:
a increase ventilaiton
b Administer bicarb
c decrease ventilation
d increase FIO2

AAAARG!

[deeDawntee]

Definitely increase ventilation! It blows off the CO2 very effectively. Bicarb would be a second choice depending on how severe the acidosis is and how quickly the increased ventilation would correct the pH. Increasing the FIO2 would increase the pO2, but would do nothing to blow off the CO2.

[sharrie]

Originally Posted by poohbear1968

Thanks,

Yes it is a practice question We are able to use any source to find the answer but I cant seem to find it anywhere! The question was:

The most important treatment for a patient in cardio-respiratory arrest with respiratory acidosis is:
a increase ventilaiton
b Administer bicarb
c decrease ventilation
d increase FIO2

AAAARG!

I would say the most important treatment for any patient in coardio-respiratory arrest is airway, breathing and circulation. The respiratory acidosis unless it is prolonged (i.e. over 15 minutes) is irrelevant. The guidlines actually discourage the use of bicarb unless the pH is below 7.1 (I think although I may need to check that one)

If you give good basic life support with adequate ventilations you will deal with the acidosis, if you concentrate on anything else the patient is not going to survive anyway so it is a mute point.

I quite like the resuscitation council UK as a resource for resuscitation issues. The web address is http://www.resus.org.uk/pages/als.pdf

look at page 15 for use of bicarb - not recommended routinely



Not sure where this fits into your question, but giving bicarb I would say no, you don't want to alter ventilations as in arrest the guidelines are prescriptive so probably I would say increase FiO2.

[criticalHP]

Not sure where this fits into your question, but giving bicarb I would say no, you don't want to alter ventilations as in arrest the guidelines are prescriptive so probably I would say increase FiO2.[/quote]


I do agree with half of your statement here: Giving bicarb is not recommended. But increasing the FiO2 will only serve to increase the PO2; It does nothing the decrease the PCO2 level in resp. acidosis. To decrease PCO2 increase ventilations to blow off CO2.
Respectfully submitted.

[sharrie]

Originally Posted by criticalHP

Not sure where this fits into your question, but giving bicarb I would say no, you don't want to alter ventilations as in arrest the guidelines are prescriptive so probably I would say increase FiO2.

I do agree with half of your statement here: Giving bicarb is not recommended. But increasing the FiO2 will only serve to increase the PO2; It does nothing the decrease the PCO2 level in resp. acidosis. To decrease PCO2 increase ventilations to blow off CO2.
Respectfully submitted.

I would agree with you absolutely, but during cardiac arrest the compression / ventilation guidance is very prescriptive so post arrest then yest I would say alter ventilations however during resuscitation I would say stick to the guidence

[SMK1]

Originally Posted by poohbear1968

Thanks,

Yes it is a practice question We are able to use any source to find the answer but I cant seem to find it anywhere! The question was:

The most important treatment for a patient in cardio-respiratory arrest with respiratory acidosis is:
a increase ventilaiton
b Administer bicarb
c decrease ventilation
d increase FIO2

AAAARG!

It seems to me that this question is designed to see if you understand respiratory acidosis and compensatory mechanisms. If you are in respiratory acidosis your CO2 levels are too high probably due to hyoventilation. If you increase the ventilations then you blow off CO2 and decrease (hopefully) the pH level. If this doesn't work then the bicarb would come into play, but that mechanism takes longer to activate, so I would say increase ventilation should be the answer. Of course I agree that the wording of the question is suspect because "during" the arrest none of this takes precedence over ABC's.

[SEOBowhntr]

Originally Posted by SMK1

It seems to me that this question is designed to see if you understand respiratory acidosis and compensatory mechanisms. If you are in respiratory acidosis your CO2 levels are too high probably due to hyoventilation. If you increase the ventilations then you blow off CO2 and decrease (hopefully) the pH level. If this doesn't work then the bicarb would come into play, but that mechanism takes longer to activate, so I would say increase ventilation should be the answer. Of course I agree that the wording of the question is suspect because "during" the arrest none of this takes precedence over ABC's.

Excellent post, and I agree 100%.

Poohbear,
The only answer that accomplishes what you are trying to accomplish is INCREASING ventilation. Now if the acidosis remains, then there are a couple of things that must be considered. But generally the causes of a respiratory acidosis is hypoventilation, therefore you need to increase ventilation. The use of Bicarb isn't necessarily a good thing, because the body may already be compensating by pushing itself into a metabolic alkalosis especially if this is a long-term COPD-er known to retain CO2. Other more advanced answers might be increase Tidal Volume, and some tinkering with PEEP, Pressure Support, etc.

Poohbear,
You certainly seem to have a vigor for learning, that should make you a GOOD NURSE!!!