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| {| {{table}}
| | #REDIRECT[[ACLS (Main)]] |
| | align="center" style="background:#f0f0f0;"|'''Condition'''
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| | align="center" style="background:#f0f0f0;"|'''Common clinical settings'''
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| | align="center" style="background:#f0f0f0;"|'''Corrective actions'''
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| |-
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| | [[Acidosis]]||
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| *Preexisting acidosis, DM, diarrhea, drugs and toxins, prolonged resuscitation, renal disease, shock
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| *Reassess adequacy of oxygenation, and ventilation; reconfirm endotracheal-tube placement
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| *Hyperventilate *Consider intravenous bicarbonate if pH <7.20 after above actions have been taken
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| | [[Cardiac tamponade]]||
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| *Hemorrhagic diathesis, cancer, pericarditis, trauma, after cardiac surgery or MI
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| *Give fluids; obtain bedside echocardiogram
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| *Perform pericardiocentesis. Immediate surgical intervention is appropriate if pericardiocentesis is unhelpful but cardiac tamponade is known or highly suspected.
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| | [[Hypothermia]]||
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| *Alcohol abuse, burns, CNS disease, debilitated or elderly patient, drowning, drugs and toxins, endocrine disease, history of exposure, homelessness, extensive skin disease, spinal cord disease, trauma
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| *If severe (temperature <30°C), limit initial shocks for V-Fib or pulseless V-Tach to three; initiate active internal rewarming and cardiopulmonary support. Hold further resuscitation medications or shocks until core temperature is >30°C.
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| *If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas
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| | [[Hypovolemia]], [[hemorrhage]], [[anemi]]a||
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| *Major burns, DM, GI losses, hemorrhage, hemorrhagic diathesis, cancer, pregnancy, shock, trauma
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| *Give fluids *Transfuse pRBCs if hemorrhage or profound anemia is present
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| *Thoracotomy is appropriate when patient has cardiac arrest from penetrating trauma and a cardiac rhythm and the duration of cardiopulmonary resuscitation before thoracotomy is <10 min
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| |-
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| | [[Hypoxia]]||
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| *Consider in all patients with cardiac arrest||Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
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| | [[Hypomagnesemia]]||
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| *Alcohol abuse, burns, DKA, severe diarrhea, diuretics, drugs (eg, cisplatin, cyclosporine, pentamidine)
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| *Give 1-2 g magnesium sulfate intravenously over 2 min
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| | [[Myocardial infarction]]||
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| *Consider in all patients with cardiac arrest, especially those with a history of coronary artery disease or prearrest acute coronary syndrome
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| *Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass)
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| | [[Poisoning]]||
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| *Alcohol abuse, bizarre or puzzling behavioral or metabolic presentation, classic toxicologic syndrome, occupational or industrial exposure, and psychiatric disease
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| *Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote
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| *Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available
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| | Hyperkalemia||
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| *Metabolic acidosis, excessive administration of potassium, drugs and toxins, vigorous exercise, hemolysis, renal disease, rhabdomyolysis, tumor lysis syndrome, and clinically significant tissue injury
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| *If hyperkalemia is identified or strongly suspected, treat with all of the following: 10% calcium chloride (5-10 mL by slow intravenous push; do not use if hyperkalemia is secondary to digitalis poisoning), glucose and insulin (50 mL of 50% dextrose in water and 10 units of regular insulin intravenously), sodium bicarbonate (50 mmoL intravenously; most effective if concomitant metabolic acidosis is present), and albuterol (15-20mg nebulized or 0.5mg by intravenous infusion)
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| |-
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| | Hypokalemia||
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| *Alcohol abuse, diabetes, use of diuretics, drugs and toxins, profound gastrointestinal losses, hypomagnesemia
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| *If profound hypokalemia (<2-2.5 mmoL of potassium per liter) is accompanied by cardiac arrest, initiate urgent intravenous replacement (2 mmoL/min intravenously for 10-15 mmoL), then reassess
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| | Pulmonary embolism||
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| *Hospitalized patient, recent surgical procedure, peripartum, known risk factors for venous thromboembolism, history of venous thromboembolism, or prearrest presentation consistent with diagnosis of acute pulmonary embolism
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| *Administer fluids; augment with vasopressors as necessary
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| *Confirm diagnosis, if possible; consider immediate cardiopulmonary bypass to maintain patient's viability *Consider definitive care (eg, thrombolytic therapy, embolectomy by interventional radiology or surgery)
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| | Tension pneumothorax||
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| *Placement of central catheter, mechanical ventilation, pulmonary disease (including asthma, chronic obstructive pulmonary disease, and necrotizing pneumonia), thoracentesis, and trauma
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| *Needle decompression, followed by chest-tube insertion
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| |}
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| ==See Also==
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| [[ACLS (Main)]] | |
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| [[Category:Critical Care]]
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| [[Category:Cardiology]]
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| [[Category:EMS]]
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