sleepy17

During my clinical, I had a patient who had to go to the cath lab. The GFR was low, so the patient was given a bicarb drip. Could anyone explain the physiology behind this?

Oh dear, I did mean metabolic, not respiratory! My apologies. Thank you all who have responded so far :)

I have to get THIS off my chest. I'm really sick of nurses berating other nurses/not having each other's backs. Just because you don't work in a hospital doesn't mean you are not a "real nurse". You are doing a job that you love, makes you happy, and does require a lot of critical thinking! You earned that nursing degree and as a result have a job to show for it. Some people really want to pity themselves/go on some ego trip to try to prove to others that they are some top achiever or the best nurse in the world. Please. They think it makes them sound more important, but really, they just sound pathetic and self-conscious. Keep on doing an awesome job. Nurses are needed everywhere, and your job is just as important as any :)

Another question from a student new to the ICU. 1) I have seen bicarb drips started for pts in respiratory acidosis with a lower than normal pH. Is it only resp acidosis in which this is useful? 2) At what pH would you consider starting a bicarb gtt/pushing bicarb? Just anything below 7.35? 3) Is there a point at which pushing bicarb or starting a drip is a "lost cause"? 4) Any other indications of why you would start a bicarb gtt or push bicarb? 5) Do you essentially keep checking ABGs, and stop the drip when the pH has corrected itself? I was following a new RN who said that you need to recheck the bicarb level to see if it is corrected, but this doesn't make sense...don't you want to check the pH, technically? Sorry this is kind of a dumb question, but I can't find a lot of info in my text books. :/

Makes sense. So, in summation, this person should be intubated right off the bat because of resp distress AND inability to protect their airway (not to mention, all the contraindications for a bipap)

Hello... I'm a student with a clinical rotation in the MICU, and I was hoping to have an experience clarified. I recently followed a patient who was on the BiPap with worsening ABG's throughout the day. This patient had a hx of liver cirrhosis. She was scoped for an upper GIB, which was positive, although they didn't band any varices. The patient ended up being intubated, which was very traumatic and bloody to say the least. Some were saying that the pt should have never been on the bipap with a GIB in the first place. Is this because of a risk of aspiration, or because it made her throat more dry/bloody? Rationale would be appreciated.