Acidosis

Diabetes, diarrhea, drugs, toxins, prolonged resuscitation, renal failure, hypercarbic respiratory failure, shock, sepsis, preexisting acidosis

• Ensure appropriate ventilation, consider Hyperventilation.
• If pH <7.20 consider HCO3.

Hypothermia

EtOH, burns, CNS disease, debilitated, homeless, or elderly, drowning, drugs, toxins, endocrine disease, exposure, trauma, spinal cord disease

• If severe (<30ºC), consider limiting vasoactive medications and defibrillation for VF/VT up to three times.
• Active internal warming and resuscitation.
• Once T >30ºC, then restart ACLS.

Hypovolemia

Hemorrhage, diabetes, GI loss, shock, major burns, trauma

• Fluids, PRBCs, look for site of loss if applicable.

Hypoxia

Consider in all patients with cardiac arrest.

• Ensure adequate CPR, oxygenation, ventilation, correct ETT placement.

Hypokalemia

EtOH, diabetes, diuretic use, drugs, toxins, profound GI loss, hypomagnesemia

• If <2.5 mEq/L and associated with cardiac arrest, give 2 mEq/min IV up to 10-15 mEq and reassess.

Hyperkalemia

Renal failure, ESRD, metabolic acidosis, drugs, toxins, hemolysis, rhabdomyolysis, massive tissue injury

• 10% calcium chloride 5-10 ml IV slow push).
• 1 amp D50 IV with 10U regular insulin IV.
• 1-2 amps of HCO3 IV.
• Albuterol nebs.

Hypomagnesemia

EtOH, DKA, severe diarrhea, diuretics, burns, drugs

• 1-3 g IV MgSO4 IV over 2 minutes.

Myocardial infarction

Consider in all patients with cardiac arrest and especially those with pre-existing coronary disease or risk factors.

• Obtain an immediate post ROSC ECG or 12-lead ECG.
• Consider thrombolytics, emergent cardiac catheterization, or urgent CABG.

Cardiac tamponade

Hemorrhagic diathesis, post MI, pericarditis, trauma, post-cardiac intervention/surgery

• Administer fluids.
• Obtain bedside ultrasound.
• Evaluate for pulsus.
• Urgent pericardiocentesis.
• Surgical intervention if appropriate.

Poisoning

EtOH, unusual behavioral or metabolic presentation, exposure, psychiatric disease, classic toxicological syndrome

• Send tox screen, consult toxicologist.
• Treat suspected ingestion.
• Prolonged resuscitation may be appropriate.

Pulmonary embolism

Hospitalized patient, recent surgery, peripartum, history of DVT, risk factors for DVT

• Consider bedside ultrasound to evaluate for RH strain and look for DVT.
• Thrombolytics or urgent surgical intervention.

Tension pneumothorax

Placement of central line, mechanical ventilation, lung disease, thoracentesis, trauma

• Needle decompression: 14 gauge angiocatheter at 2nd intercostal space, mid clavicular line.
• Chest tube placement.