|
|
| (14 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| {| cellspacing="0" style="border-color: rgb(211, 211, 211) rgb(0, 0, 0) rgb(211, 211, 211) rgb(211, 211, 211); border-width: 1px; border-style: dotted solid dotted dotted; text-align: left; font-size: 0.75em; padding: 0px; margin: 0px; width: 1012px;" class="cke_show_border"
| | #REDIRECT[[ACLS (Main)]] |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(0, 0, 0) rgb(0, 0, 0); border-width: 1px 1px 3px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: middle; padding: 0.8em 0.6em 0.3em; text-align: center; font-size: 1.2em; font-weight: bolder; background-color: rgb(238, 238, 238);" class="subtitle1" | Condition
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(0, 0, 0) rgb(0, 0, 0); border-width: 1px 1px 3px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: middle; padding: 0.8em 0.6em 0.3em; text-align: center; font-size: 1.2em; font-weight: bolder; background-color: rgb(238, 238, 238);" class="subtitle1" | Common clinical settings
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(0, 0, 0) rgb(0, 0, 0); border-width: 1px 1px 3px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: middle; padding: 0.8em 0.6em 0.3em; text-align: center; font-size: 1.2em; font-weight: bolder; background-color: rgb(238, 238, 238);" class="subtitle1" | Corrective actions
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="3" | Acidosis
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="3" | Preexisting acidosis, DM, diarrhea, drugs and toxins, prolonged resuscitation, renal disease, shock
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Reassess adequacy of oxygenation, and ventilation; reconfirm endotracheal-tube placement
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Hyperventilate
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Consider intravenous bicarbonate if pH <7.20 after above actions have been taken
| |
| |- class="divider_top"
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="2" | Cardiac tamponade
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="2" | Hemorrhagic diathesis, cancer, pericarditis, trauma, after cardiac surgery or MI
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Give fluids; obtain bedside echocardiogram
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Perform pericardiocentesis. Immediate surgical intervention is appropriate if pericardiocentesis is unhelpful but cardiac tamponade is known or highly suspected.
| |
| |- class="divider_top"
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="2" | Hypothermia
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="2" | 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
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | 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.
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas
| |
| |- class="divider_top"
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="3" | Hypovolemia, hemorrhage, anemia
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" rowspan="3" | Major burns, DM, GI losses, hemorrhage, hemorrhagic diathesis, cancer, pregnancy, shock, trauma
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Give fluids
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Transfuse pRBCs if hemorrhage or profound anemia is present
| |
| |-
| |
| | style="border-color: rgb(211, 211, 211) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: dotted dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Thoracotomy is appropriate when pt has cardiac arrest from penetrating trauma and a cardiac rhythm and the duration of cardiopulmonary resuscitation before thoracotomy is <10 min
| |
| |- class="divider_top"
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Hypoxia
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Consider in all patients with cardiac arrest
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
| |
| |- class="divider_top"
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Hypomagnesemia
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Alcohol abuse, burns, DKA, severe diarrhea, diuretics, drugs (eg, cisplatin, cyclosporine, pentamidine)
| |
| | style="border-color: rgb(0, 0, 0) rgb(211, 211, 211) rgb(221, 221, 221) rgb(0, 0, 0); border-width: 1px; border-style: solid dotted solid solid; font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; padding: 0.4em 0.6em 0.6em;" | Give 1-2 g magnesium sulfate intravenously over 2 min
| |
| |}
| |
| | |
| <br>
| |
| | |
| {| cellspacing="0" style="text-align: left; border-right: 1px solid rgb(0, 0, 0); font-size: 0.75em; padding: 0px; margin: 0px; width: 1012px;"
| |
| |-
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Myocardial infarction
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Consider in all patients with cardiac arrest, especially those with a history of coronary artery disease or prearrest acute coronary syndrome
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass)
| |
| |- class="divider_top"
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" rowspan="2" | Poisoning
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" rowspan="2" | Alcohol abuse, bizarre or puzzling behavioral or metabolic presentation, classic toxicologic syndrome, occupational or industrial exposure, and psychiatric disease
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote
| |
| |-
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available
| |
| |- class="divider_top"
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Hyperkalemia
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Metabolic acidosis, excessive administration of potassium, drugs and toxins, vigorous exercise, hemolysis, renal disease, rhabdomyolysis, tumor lysis syndrome, and clinically significant tissue injury
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | If hyperkalemia is identified or strongly suspected, treat with all of the following: 10 percent 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 percent 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 (15-20 mg nebulized or 0.5 mg by intravenous infusion)
| |
| |- class="divider_top"
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Hypokalemia
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Alcohol abuse, diabetes, use of diuretics, drugs and toxins, profound gastroinstestinal losses, hypomagnesemia
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | If profond 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
| |
| |- class="divider_top"
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" rowspan="3" | Pulmonary embolism
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" rowspan="3" | 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
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Administer fluids; augment with vasopressors as necessary
| |
| |-
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Confirm diagnosis, if possible; consider immediate cardiopulmonary bypass to maintain patient's viability
| |
| |-
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em;" | Consider definitive care (eg, thrombolytic therapy, embolectomy by interventional radiology or surgery)
| |
| |- class="divider_top"
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Tension pneumothorax
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Placement of central catheter, mechanical ventilation, pulmonary disease (including asthma, chronic obstructive pulmonary disease, and necrotizing pneumonia), thoracentesis, and trauma
| |
| | style="font-family: Verdana,Arial,Helvetica,sans-serif; margin: 0px; vertical-align: top; border-left: 1px solid rgb(0, 0, 0); border-bottom: 1px solid rgb(221, 221, 221); padding: 0.4em 0.6em 0.6em; border-top: 1px solid rgb(0, 0, 0);" | Needle decompression, followed by chest-tube insertion
| |
| |}
| |
| | |
| == See Also ==
| |
| [[ACLS (Main)]] | |
| | |
| [[Category:Critical Care]]
| |
| [[Category:Cardiology]]
| |
| [[Category:EMS]]
| |
