Caring for a septic lady in her 30's alongside a young-ish new ER doctor. Patient very sick with multi-organ involvement. Just intubated, central-lined, vasopressors, etc.
Was given two amps bicarb prior to/during intubation (unable to obtain ABG's prior to intubation d/t poor perfusion/pulses etc., but bicarb/CO2 by chemistries was 9)
30 minutes after intubation ABG's show a pH of 7.0. Bicarb of 13. Base Excess of -15.
I approach the doctor...
Me: " Hey did you see the ABG's?? You want me to give any more bicarb?.."
Doctor: "...No...(waving his hand at the results rather off-handedly) ..this is all metabolic...
bicarb wont cure anything..."
Ummm. How would you respond to this? (true story...true conversation...true hand gesturing)