January 16, 2026

The buffer system decoded: Mastering CO2, pH and patient care

41 minutes

In this episode of the Inside EMS podcast, Chris and Kelly are joined by paramedic student April McKenzie — aka “April Anonymous” — for a deep dive into the buffer system and CO2 mapping.

April’s in the thick of paramedic school and like every good learner, she’s asking “why?” — so the guys break down the physiology behind capnography, acid-base balance and the lungs-vs.-kidneys showdown that keeps our patients alive. Plus, they throw in old-school war stories, rant about naloxone misuse and admit that bicarb is no longer the go-to cardiac arrest drug.

If you've ever tried to explain respiratory vs. metabolic acidosis in under 10 minutes, this episode is your cheat sheet. April will be back throughout the year with more student questions, so buckle up for the ongoing EMS education you didn’t know you needed.

Quotable takeaways

“Just because you see somebody with signs and symptoms and the protocol says, do this; that's OK, but that just makes you a protocol paramedic.”

“My friend Romy Duckworth calls [capnography] the MVP of vital signs, and that's a good way to remember it — MVP: Metabolism, Ventilation and Profusion. And it will tell you derangement about all three of those things very well once you're proficient at interpreting the waveforms.”

“Basically, the buffer system is the body's way of keeping the pH stable. So, if we're blowing out, if we're having problems with respiratory acidosis — and let's talk about CDKA, where they're trying to blow off — it's the respiratory systems’ way of making sure that we have homeostasis.”

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