What is included in prehospital treatment of lactic acidosis?

Updated: Dec 09, 2020
  • Author: Bret A Nicks, MD, MHA; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Answer

Initial treatment of lactic acidosis predicates an understanding of basic resuscitation, macrohemodynamic monitoring, and the ability to have testing modalities present to identify the elevation. The prognostic value of point-of-care lactate testing in prehospital care has been shown to be a complementary tool that can be used to guide early detection of critical patients. [12, 13] While in most circumstances, hypoperfusion follows sustained hypotension, there are patients with cryptic shock in whom, as assessed using the macrohemodynamic-monitoring guidelines, lactic acidosis may not be detected as early as in other patients. Protocol-driven care in the prehospital setting emergently addresses early resuscitation concurrent with emergent facility transport. Airway assessment, including oxygenation and ventilation considerations, and stabilization are essential for all patients. Supplemental oxygen should be considered concurrent with serial reassessments, especially with any decline in a patient's mental status or vital signs.

Acute resuscitation, including intravenous (IV) 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 patients to dysrhythmias, including tachydysrhythmia and fibrillation (see Normal Vital Signs). While several different noninvasive devices can provide continuous monitoring of tissue perfusion, including those that monitor microhemodynamic parameters, and may represent a surrogate for lactate monitoring, [14] 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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