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Sodium Bicarbonate dilemma
Hello, I have a few questions about the administration of sodium bicarbonate in patients with metabolic acidosis, such as those with DKA or CKD. We're facing a dilemma regarding when to administer sodium bicarbonate. Should we base our decision on the clinical appearance of the patient or strictly on ABG or VBG results? What is the consensus on the pH level at which sodium bicarbonate should be given? Some sources suggest a pH of 6.9, while others, especially critical care colleagues, recommend administering it at a pH below 7.2. Additionally, some internal medicine colleagues suggest administering sodium bicarbonate based on clinical signs like Kussmaul respirations. Lastly, could you advise on the appropriate dosage of sodium bicarbonate? I apologize for the multitude of questions, and thank you in advance. I'm a big fan of your podcast!
Malfunctioning pacemaker
In a non-hospital environment such as a cruise ship, how can I handle a situation where a patient has a malfunctioning pacemaker that is continuously firing and causing them pain? i hope you can make an episode regarding this topic. Thank you and more power to your podcast!