So, how to remember the H's and T's, the common causes of PEA, asystole, and refractory cardiac arrest that is resistant to both shock and drug therapy?
Here is my preferred way:
6 H's - Imagine a diabetic patient, coming in by ambulance on your shift after passing out at his granddaughter's ice cream birthday party. You are getting report on this patient while standing in the emergency department, ETA 5 minutes. The paramedic tells you over the phone that the patient has a wide QRS complex, and his vitals are as follows:
Bloood pressure- 86/58
Pulse, 86
SPO2, 86
Temp 86 degrees Fahrenheit.
What do we make of this patient? First of all, we noted that he is a diabetic. Diabetics can have ketoacidosis. (H= Hydrogen Ion) He has a wide QRS complex, which is very common with hyperkalemia. It can also happen with severe hypokalemia (H= Hyper or Hypokalemia) Next, lets look at the vitals. His blood pressure is low. One of the causes of low pressure is not enough volume. (H= Hypovolemia) His pulse is OK. His oxygen saturation, however, is low. (H=Hypoxia) and he has a low temperature. (H= Hypothermia)
H= Hydrogen Ion= acidosis, treatment is sodium bicarb. diabetics can also have Hypoglycemia, no longer considered a core H, but still very important to consider in refractory arrest
H= Hyperkalemia Severe hyperkalemia may require dialysis.
H= Hypokalemia, treated with potassium
H= hypovolemia is treated with IV fluid boluses
H= hypoxia, identify and treat the cause
H= Hypothermia. Warm him up!
That's the H's. I would love to take credit for this, because I believe it is a brilliant way to remember them, but I can't. You can find the video here:
http://www.youtube.com/watch?v=g8qQ68ndkmI
The more detailed you make the scenario in your mind, the easier it is to remember.
Now for the 5 T's:
Imagine a pro-coagulant laced lead bullet, fired into someone's chest. Pro-coagulant means that it can cause clotting, in other words, a thrombus. (T= a Pulmonary Thrombus, or embolus -PE, or a coronary thrombus, MI.) Lead is a Toxin. (T= Toxin. ) A bullet to the chest could certainly cause a tension pneumothorax, a collapsed lung with increased pressure. (T=Tension pneumothorax), or a cardiac tamponade (T= Tamponade) Lastly, a bullet wound is certainly traumatic. Trauma is no longer considered a core T, but is another helpful way to remember that multiple organ injury, and hypovolemia, etc, are important factors.
T= a Pulmonary Thrombus, or embolus -PE, PE thrombi should receive TPA. This is a difficult diagnosis to make, and is often done by history.
T= coronary Thrombus, MI. MI ultimately should be treated with cardiac catheterization
T= Toxin. Usually when we speak of toxins, we are talking about tri cyclic antidepressaant overdaose, requiring LOTS of bicarb, or perhaps calcium channel blocker overdose, requiring calcium, etc
T=Tension hemo/pneumothorax, requiring needle decompression
T= cardiac Tamponade, also requiring a needle.
Alas, this also is not mine. The video link for this one is here:
http://www.youtube.com/watch?v=923lXP4e9Zs
Here is my preferred way:
6 H's - Imagine a diabetic patient, coming in by ambulance on your shift after passing out at his granddaughter's ice cream birthday party. You are getting report on this patient while standing in the emergency department, ETA 5 minutes. The paramedic tells you over the phone that the patient has a wide QRS complex, and his vitals are as follows:
Bloood pressure- 86/58
Pulse, 86
SPO2, 86
Temp 86 degrees Fahrenheit.
What do we make of this patient? First of all, we noted that he is a diabetic. Diabetics can have ketoacidosis. (H= Hydrogen Ion) He has a wide QRS complex, which is very common with hyperkalemia. It can also happen with severe hypokalemia (H= Hyper or Hypokalemia) Next, lets look at the vitals. His blood pressure is low. One of the causes of low pressure is not enough volume. (H= Hypovolemia) His pulse is OK. His oxygen saturation, however, is low. (H=Hypoxia) and he has a low temperature. (H= Hypothermia)
H= Hydrogen Ion= acidosis, treatment is sodium bicarb. diabetics can also have Hypoglycemia, no longer considered a core H, but still very important to consider in refractory arrest
H= Hyperkalemia Severe hyperkalemia may require dialysis.
H= Hypokalemia, treated with potassium
H= hypovolemia is treated with IV fluid boluses
H= hypoxia, identify and treat the cause
H= Hypothermia. Warm him up!
That's the H's. I would love to take credit for this, because I believe it is a brilliant way to remember them, but I can't. You can find the video here:
http://www.youtube.com/watch?v=g8qQ68ndkmI
The more detailed you make the scenario in your mind, the easier it is to remember.
Now for the 5 T's:
Imagine a pro-coagulant laced lead bullet, fired into someone's chest. Pro-coagulant means that it can cause clotting, in other words, a thrombus. (T= a Pulmonary Thrombus, or embolus -PE, or a coronary thrombus, MI.) Lead is a Toxin. (T= Toxin. ) A bullet to the chest could certainly cause a tension pneumothorax, a collapsed lung with increased pressure. (T=Tension pneumothorax), or a cardiac tamponade (T= Tamponade) Lastly, a bullet wound is certainly traumatic. Trauma is no longer considered a core T, but is another helpful way to remember that multiple organ injury, and hypovolemia, etc, are important factors.
T= a Pulmonary Thrombus, or embolus -PE, PE thrombi should receive TPA. This is a difficult diagnosis to make, and is often done by history.
T= coronary Thrombus, MI. MI ultimately should be treated with cardiac catheterization
T= Toxin. Usually when we speak of toxins, we are talking about tri cyclic antidepressaant overdaose, requiring LOTS of bicarb, or perhaps calcium channel blocker overdose, requiring calcium, etc
T=Tension hemo/pneumothorax, requiring needle decompression
T= cardiac Tamponade, also requiring a needle.
Alas, this also is not mine. The video link for this one is here:
http://www.youtube.com/watch?v=923lXP4e9Zs
