ACLS (Treatable Conditions)
| 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 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 |
See Also
Authors:
Jordan Swartz, Neil Young, Daniel Ostermayer, Ross Donaldson