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 gastroinstestinal losses, hypomagnesemia
|
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
|
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
|