American journal of therapeutics
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Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments, and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation act. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterization laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, playing field, difficult environment (eg, drowning, high altitude, avalanche, and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease, and obesity) and pregnant women or older people. ⋯ In special circumstances, ALS guidelines require modification and special attention for causes, environment, and patient particularities, with specific therapeutic intervention concomitant with standard ALS.
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Acute pulmonary embolism (PE) requires rapid diagnosis and early and appropriate treatment, often under conditions of hemodynamic instability. The therapeutic strategy should optimally integrate the therapeutic arsenal in a multidisciplinary but unitary approach. ⋯ Nowadays, evidence and ideas have been gathered that can significantly improve the outcome of patients with PE with varying degrees of severity, remaining to demonstrate the cost-effectiveness of this advanced therapeutic approach.