Quick ER questions(lido, ABGs)

leslie :-D · Aug 21, 2008

Hi. I am working on a long ENA ER module and am stuck on some questions?
I know lidocaine is contraindicated with patients with heart blocks. Can someone explain why in simple terms? I know lidocaine makes the conduction through the sinus and atrioventricular nodes to be suppressed. Is this why?
Also, why cant one give socium bicarb for a patient with metabolic acidosis, especifically DKA. I have looked through my patho and med/surg book and cant find anything.
Thank you so much for helping a new ER nurse...:)

- yes, lidocaine can cause heart block.

- na hco3 can be given but it is given with extreme caution.

usually treating the underlying cause of metabolic acidosis, will suffice in reversing it.

as for dka, it's a controversial treatment but not contraindicated per se.

this is based on a diabetic's likelihood of nephropathy in the first place.

compound that with arf or a complication from dialysis, pt's kidneys must be able to excrete hydrogen ions in order to regenerate the hco3.

in other words, functional kidneys are indicated in order to administer a potentially renal toxic drug.

but for the docs who do use hco3 tx, it's not because it's the tx of choice but are weighing risk vs benefits.

unless the pH is critically low (i think, less than 7.2?) hco3 is usually unnecessary.

leslie

NurseyPoo7 · Aug 21, 2008

Would you need to do monitoring for pts recieving Na hco3?

(e.g. whenever I give Kcl or mag runs, I always monitor the pts BP frequently b/c they can both cause hypotension)

clairebearrn · Aug 21, 2008

I know that what I was thinking about NAHCO3. The benefits must outweigh the risks, but the questions was like "why should you not give it?" (even though the patient was a healthy person other than the DM) For this patient, I would give it, but I guess the module must be old...I guess thats what I will discuss with my Nurse Educator. Thanks. I just shoudnt second guess myself. :)

clairebearrn · Aug 21, 2008

Would you need to do monitoring for pts recieving Na hco3?
(e.g. whenever I give Kcl or mag runs, I always monitor the pts BP frequently b/c they can both cause hypotension)

For sodium bicarb, hypokalemia can occur, so I would due to those reasons.

leslie :-D · Aug 21, 2008

Would you need to do monitoring for pts recieving Na hco3?

absolutely.

remember, iv hco3 is given in an emergent situation only.

and, it carries many risks.

volume overload/hypernatremia, hypokalemia, hypercapnia, hypocalcemia, etc.

it is to be given very cautiously and monitored just as closely.

leslie

SFRN · Aug 21, 2008

Also remember that if you have a pt. with high sodium and need of bicarb---THAM is a GREAT alternative!

Dixielee, BSN, RN · Aug 21, 2008

As far as lido and heart block....remember that any heart beat is better than no heart beat at all. Your ventricular rhythm may be the only thing coming thru, and with lido you will supress that. Plus with a block, you are likely to have a brady arrhythmia, so you would not use lido anyway.

With DKA, as well as other metabolic acidosis problems, you need to treat the underlying cause rather than just give bicarb. If you don't treat the underlying cause, all the bicarb in the world is not going to help.

As to monitoring when pts are getting K+ runs or Mg...they need to be on a cardiac monitor and watched closely. Just taking frequent vitals are not enough, you need to visualize the rhythm.

OK, I have exhaused all my working knowledge and am going to bed. :typing

NurseyPoo7 · Aug 21, 2008

absolutely.
remember, iv hco3 is given in an emergent situation only.
and, it carries many risks.
volume overload/hypernatremia, hypokalemia, hypercapnia, hypocalcemia, etc.
it is to be given very cautiously and monitored just as closely.
leslie

Do they give na hco3 straight up? Most of the time when Im on the floor, Ive only seen a amp or 2 of na hco3 mixed in 1L of fluid.

leslie :-D · Aug 21, 2008

Do they give na hco3 straight up? Most of the time when Im on the floor, Ive only seen a amp or 2 of na hco3 mixed in 1L of fluid.

it's all going to depend on what's going on with the pt.

it's been given bolus as well as infusion.

it can be given rapidly (as in, for cardiac arrest) or it can be given over sev'l hrs for less urgent situations.

or, be given po.

there isn't really any 'standard' for nahco3.

but to answer your question, yes, it can be given 'straight up'.

leslie