What is included in prehospital treatment of lactic acidosis?

Updated: Aug 18, 2020
  • Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Initial treatment of lactic acidosis predicates an understanding of basic resuscitation and the ability to have testing modalities present to identify the elevation. In most circumstances, this refers to patients being emergently transferred between facilities to a higher level of care, or presumptive care in the prehospital setting. Airway assessment, including oxygenation and ventilation considerations, and stabilization are essential for all patients. Supplemental oxygen should be considered concurrent with serial reassessments, especially if the patient's mental status or vital signs decline.

An intravenous (IV) line should be established, and fluid repletion with crystalloids may be initiated if the patient exhibits tachycardia, hypotension, or other signs of poor tissue perfusion (eg, poor capillary refill, cool extremities). Vital signs and cardiac rhythm must be monitored closely, because acidosis predisposes to dysrhythmias, including tachydysrhythmia and fibrillation (see Normal Vital Signs). While several different noninvasive devices can provide continuous monitoring of tissue perfusion, a surrogate for lactate monitoring, [13] these remain rare in the prehospital setting.

Established prehospital treatment protocols should be followed, and nonprotocol medications, such as sodium bicarbonate, should be administered only in conjunction with medical control. Transport all patients to the appropriate emergency or predesignated facility for further management.

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