FIELD REFERENCE
Full criteria & treatment guidance
Indications
- I-15 lists major-muscle crush injury lasting more than one hour and cardiac arrest after ten minutes of arrest management. Follow the applicable adult condition order and route restrictions; this is not routine medication for every arrest or every cause of acidosis. Pediatric authority must be established separately.
Contraindications & local exclusions
- The cited injection label excludes chloride loss from vomiting/continuous GI suction and diuretics known to produce hypochloremic alkalosis.
Precautions
- Sodium/volume overload, alkalosis, electrolyte disturbances and extravasation injury are risks. Check compatibility and the precise indication, concentration and age-specific directions.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Confirm whether the preparation is 7.5% or 8.4%, and distinguish milliliters from mEq.
- I-15 specifies IO use when the patient is unconscious and IV access cannot be established.
Use in OCEMS
- I-15 lists major-muscle crush injury lasting more than 1 hour and cardiac arrest after 10 minutes of arrest management.
- Use the applicable resuscitation/crush order; this is not a routine medication for every arrest or every acidosis.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| I-15 listed indications | One 50 mL prefilled syringe IV or IO. Inventory includes 8.4% (1 mEq/mL) and 7.5% (44.6 mEq/50 mL) preparations, which do not contain identical mEq totals. |
Pediatric
- I-20 contains a sodium-bicarbonate row with IV/IO dose and volume by weight band; the smallest-weight entries include a 1:1 saline dilution note.
- The current SO-P-040 arrest pathway does not list routine bicarbonate. A chart entry alone does not establish an indication or authority: confirm the relevant pediatric order/base direction and exact concentration before use.
Pediatric dosing availability
- I-20 has preparation rows, but SO-P-040 does not authorize routine pediatric arrest bicarbonate. A separate applicable indication/order is needed; no routine pediatric dose is recommended here.
| Weight | OCEMS pediatric dose |
|---|---|
| Any weight | No general OCEMS pediatric dose is listed; follow the applicable order or medical direction. |
Preparation & reassessment
- Reconcile the requested dose with the actual concentration and any dilution instruction.
- Document indication, formulation, dose/volume, route, and response. Continue the underlying resuscitation or crush-injury pathway.
UNDERSTAND THE CARE
Why a preparation chart does not establish an indication
A chart can show how a medication is measured without establishing when it should be given. The pediatric arrest order does not list routine bicarbonate, so a weight-band row cannot supply missing treatment authority. Use the applicable indication and medical direction before selecting a preparation.
Applying the guidance
Check the actual concentration, requested units, dilution instructions and authorized route. Record both the formulation and amount so the receiving team can reconstruct treatment accurately. Continue the underlying resuscitation or crush-injury sequence; bicarbonate administration is not a substitute for the rest of that pathway.
Diagram text & teaching checkpoints
- Indication
- Condition order or explicit medical direction.
- Formulation
- 7.5% versus 8.4% and any dilution.
- Units
- Requested dose versus measured volume.
- Record
- Route, time, amount and clinical context.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic
- SO-P-040 — Cardiopulmonary Arrest - Pediatric
- SO-T-020 — Crush Injury - Adult / Adolescent
- Product label — SODIUM BICARBONATE injection, solution
Resolve the indication and units before preparation
Use the clinical order to establish the indication before interpreting the drug chart. I-15 identifies its adult crush-injury and arrest contexts; a listing in the pediatric volume chart does not establish routine pediatric arrest use. Preserve the condition-specific sequence and any medical direction rather than treating the syringe as a general response to acidosis.
Keep the preparation’s percentage, volume and milliequivalent content together. A 50 mL container is a volume, not a statement that every available concentration supplies the same number of mEq. For a calculation ordered in mEq, use a concentration in mEq/mL; the general mg-to-mL illustration is not the appropriate unit example.
At handoff, state why treatment was given, which preparation was used and the actual volume and units administered. I-15 also restricts its IO route to an unconscious patient when IV access cannot be established. Do not lose that route condition when reading the shortened dose row. Continue the underlying crush or resuscitation pathway.