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 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)
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Hypokalemia
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Alcohol abuse, diabetes, use of diuretics, drugs and toxins, profound gastroinstestinal losses, hypomagnesemia
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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
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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
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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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