I would say something like "well what else do you want to do? Bicarb will at least give us some time???". It drives me nuts when you are trying to push for something but the doctors will not let you.
I have not had to go over their heads before but some of my co-workers have and we usually get what we need. We have good residents too, but sometimes they don't see the problem at hand.
Good tidbits. Like someone stated earlier urine output is very important. Huge indicator in cardiac output and fluid status for open heart patients. Another piece I've learned that when you program your IV pumps double check your rate and volume to...