Cardiopulmonary resuscitation sodium bicarbonate

A 43-year-old man injected a large dose of cocaine in a suicide attempt and had a seizure and cardiopulmonary arrest, from which he was resuscitated. His arterial blood pH was 6.72 and his electrocardiogram showed a wide complex tachycardia. An infusion of sodium bicarbonate maintained the blood pH at 7.50 and the electrocardiogram became normal. The bicarbonate infusion was discontinued after 12 hours. 

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

A 13-year-old girl developed tonic-clonic seizures followed by ventricular fibrillation after subcutaneous infiltration of extensive skin abrasions with 30 mg (0.5 mg/kg) of bupivacaine over about 1 hour. She was successfully resuscitated with cardiopulmonary resuscitation and intubation, intravenous diazepam, adrenaline, and sodium bicarbonate (14). 

Lactic acidosis resulting from anaerobic metabolism should be treated by intravenous administration of sodium bicarbonate, and seizures should be controlled by the administration of anticonvulsants such as diazepam.45 Because correction of deficiencies in tissue perfusion and oxygenation is the ultimate goal of supportive therapy and is also important for the success of specific antidotal therapy, it is critically important to maintain an effective cardiac rhythm this can be accomplished with cardiopulmonary resuscitation, if necessary, in the early stages of treatment. Specific Antidotal Therapy... 

Drug overdose Life-threatening flecainide intoxication in a 2-year-old toddler occurred when syringes used for oral administration were accidentally reversed, producing a fivefold flecainide overdose 3 hours after drug administration he developed a bradycardia of 50/minute and had a cardiopulmonary arrest, requiring resuscitation and adrenaline, after which the bradycardia recurred, followed by a wide-complex tachycardia that converted rapidly to a narrow-complex tachycardia after bolus intravenous adrninistration of sodium bicarbonate [60 ]. He then remained hemo-dynamicaUy stable and in sinus rhjflhm. The serum flecainide concentration was 0.7 mg/1. 

Resuscitation from bupivacaine cardiovascular toxicity is extremely difficult. However, prompt resuscitation has been successful with standard cardiopulmonary support, including the prompt correction of acidosis by hyperventilation and administration of bicarbonate as well as epinephrine, atropine, and bretylium. Local anesthetics, especially bupivacaine, also inhibit basal and epinephrine-stimulated cAMP production. This finding places greater emphasis on aggressive epinephrine therapy during bupivacaine-induced cardiotoxicity. The (SJ-isomer, levobupivacaine, appears to have a lower propensity for cardiovascular toxicity than the racemic mixture or the (R)-isomer and has recently been approved for clinical use. Ropivacaine, another newer local anesthetic, has clinical effects similar to those of bupivacaine but may be associated with a lower potential for cardiovascular toxicity. Ropivacaine is available only as the (S)-stereoisomer, which has inherently less affinity for the cardiac sodium channel. 

---