When most patients go into cardiac arrest they are usually have a level of Hypoxia. As Paramedics, we must address the inability of the Pulmonary System to reverse the Metabolic Acidosis. Sodium Bicarbonate was the medication of choice for years. The American Heart Association has issued many White Papers down playing the use of generic medications. We should explore more options to enhance the outcome of all patients who are diagnosed with Hypoxia. Be sure to cognitive of the fact that most patients will provide warning signs of Hypoxia prior to cardiac arrest.