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Oral case 91

Created: 4/11/2004

Sodium bicarbonate and cardiopulmonary resuscitation

You are called to the emergency room regarding a patient who is in cardiac arrest.

1. What supplies should you have on hand in order to intubate this patient?

Suction, oxygen, oral and nasal airways, a laryngoscope, and endotracheal tubes are the minimum supplies to have on hand.

2. Following intubation and ventilation, arterial blood gas on 100% FIO2 shows a pH = 7.21, paCO2 =44 mmHg, and paO2=340 mmHg. How would you manage this patient?

3. What are the risks of bicarbonate therapy?

Patients who cannot eliminate CO2 may accumulate CO2 when bicarbonate is given. This is because the bicarbonate combines with hydrogen ions to form water and CO2, and this CO2 crosses the cell membranes and may increase intracellular acidosis.

Obstetrics- mitral regurgitation

A 34-year old parturient at 38 weeks gestation presents in labor at 5 cm dilatation. She has a history of mitral regurgitation, with recent onset of increasing shortness of breath. She desires pain relief.

1. How would you proceed?

Inhalation agent toxicity

1. Compare the degree of metabolism of halothane vs enflurane vs isoflurane.

2. How do reductive and oxidative metabolism of halothane differ?

3. What is enzyme induction?

4. What drugs cause enzyme induction?

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