Peri-arrest treatment includes giving IV fluids and blood transfusions, and controlling the source of any bleeding - by direct pressure for external bleeding, or emergency surgical techniques such as esophageal banding, gastroesophageal balloon tamponade (for treatment of massive gastrointestinal bleeding such as in esophageal varices), resuscitative thoracotomy in cases of penetrating trauma or significant shear forces applied to the chest, or exploratory laparotomy in cases of penetrating trauma, spontaneous rupture of major blood vessels, or rupture of a hollow viscus in the abdomen.
If the patient is mechanically ventilated, the presence of breath sounds and the proper placement of the endotracheal tube should be verified.
[citation needed] Acidosis (hydrogen cation excess) is an abnormal pH in the body as a result of lactic acidosis which occurs in prolonged hypoxia and in severe infection, diabetic ketoacidosis, kidney failure causing uremia, or ingestion of toxic agents or overdose of pharmacological agents, such as aspirin and other salicylates, ethanol, ethylene glycol and other alcohols, tricyclic antidepressants, isoniazid, or iron sulfate.
This can be treated with proper ventilation, good CPR technique, buffers like sodium bicarbonate, and in select cases may require emergent hemodialysis.
(Note however that patients with chronic kidney disease are often more tolerant of high potassium levels as their body often adapts to it.)
Other temporizing measures may include nebulized salbutamol, intravenous insulin (usually given in combination with glucose), and sodium bicarbonate which all temporarily drive potassium into the interior of cells.
Hypokalemia is an important cause of acquired long QT syndrome, and may predispose the patient to torsades de pointes.
This condition can be recognized by the presence of a narrowing pulse pressure, muffled heart sounds, distended neck veins, electrical alternans on the electrocardiogram, or by visualization on echocardiogram.
[citation needed] Tension pneumothorax is the build-up of air into one of the pleural cavities, which causes a mediastinal shift.
[citation needed] Critical care teams also have the skill to incise the chest in the 5th intercostal space in the mid-axillary line, to evacuate air with a larger breach of the pleura.
Other traumatic events such as high speed car crashes can cause sufficient structural damage to induce arrest.