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| {| 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)]] |
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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.
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| | 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]]
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| | 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
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| | 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.
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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 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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| | 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
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| | 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
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| | 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
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| | 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
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| | 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)
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| | 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
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| <br>
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| {| cellspacing="0" style="text-align: left; border-right: 1px solid rgb(0, 0, 0); font-size: 0.75em; padding: 0px; margin: 0px; width: 1012px;"
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| | 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
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| | 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
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| | 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)
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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% 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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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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
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| | 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)
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| | 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
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| | 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
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| | 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
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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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