| Condition
|
Common clinical settings
|
Corrective actions
|
| Acidosis |
- Preexisting acidosis, DM, diarrhea, drugs and toxins, prolonged resuscitation, renal disease, shock
|
- Reassess adequacy of oxygenation, and ventilation; reconfirm endotracheal-tube placement
- Hyperventilate *Consider intravenous bicarbonate if pH <7.20 after above actions have been taken
|
| Cardiac tamponade |
- Hemorrhagic diathesis, cancer, pericarditis, trauma, after cardiac surgery or MI
|
- Give fluids; obtain bedside echocardiogram
- Perform pericardiocentesis. Immediate surgical intervention is appropriate if pericardiocentesis is unhelpful but cardiac tamponade is known or highly suspected.
|
| Hypothermia |
- 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
|
- 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.
- If moderate (temperature 30-34°C), proceed with resuscitation (space medications at intervals greater than usual), actively rewarm truncal body areas
|
| Hypovolemia, hemorrhage, anemia |
- Major burns, DM, GI losses, hemorrhage, hemorrhagic diathesis, cancer, pregnancy, shock, trauma
|
- Give fluids *Transfuse pRBCs if hemorrhage or profound anemia is present
- 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
|
| Hypoxia |
- Consider in all patients with cardiac arrest
|
- Reassess technical quality of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
|
| Hypomagnesemia |
- Alcohol abuse, burns, DKA, severe diarrhea, diuretics, drugs (eg, cisplatin, cyclosporine, pentamidine)
|
- Give 1-2 g magnesium sulfate intravenously over 2 min
|
| Myocardial infarction |
- Consider in all patients with cardiac arrest, especially those with a history of coronary artery disease or prearrest acute coronary syndrome
|
- Consider definitive care (eg, thrombolytic therapy, cardiac catheterization or coronary artery reperfusion, circulatory assist device, emergency cardiopulmonary bypass)
|
| Poisoning |
- Alcohol abuse, bizarre or puzzling behavioral or metabolic presentation, classic toxicologic syndrome, occupational or industrial exposure, and psychiatric disease
|
- Consult toxicologist for emergency advice on resuscitation and definitive care, including appropriate antidote
- Prolonged resuscitation efforts may be appropriate; immediate cardiopulmonary bypass should be considered, if available
|
| Hyperkalemia |
- Metabolic acidosis, excessive administration of potassium, drugs and toxins, vigorous exercise, hemolysis, renal disease, rhabdomyolysis, tumor lysis syndrome, and clinically significant tissue injury
|
- 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)
|
| Hypokalemia |
- Alcohol abuse, diabetes, use of diuretics, drugs and toxins, profound gastrointestinal losses, hypomagnesemia
|
- 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
|
| Pulmonary embolism |
- 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
|
- Administer fluids; augment with vasopressors as necessary
- 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)
|
| Tension pneumothorax |
- Placement of central catheter, mechanical ventilation, pulmonary disease (including asthma, chronic obstructive pulmonary disease, and necrotizing pneumonia), thoracentesis, and trauma
|
- Needle decompression, followed by chest-tube insertion
|
