How to use the H’s and T’s.

THE 6 H’s and 5 T’s – POTENTIALLY REVERSIBLE CAUSES

You must use these on all cardiac arrests and near cardiac arrests.

H’s

T’s

·        Hypovolemia

·        Hypoxia

·        Hydrogen ion – acidosis

·        Hyperkalemia / Hypokalemia

·        Hypothermia

·        Hypoglycemia

      and other metabolic disorders

·        Tablets (drug OD, accidents)

·        Tamponade (cardiac)

·        Tension pneumothorax

·        Thrombosis, coronary (ACS)

·        Thrombosis, pulmonary (embolism)

·        Trauma

Hypovolemia ( is this pt  hypovolemic?)

1.        Look for obvious fluid/blood loss.

2.        Secure IO/IV access

3.        Give fluid bolus’s and reassess

4.        Check mark for hypovolemia

Hypoxia (is this person hypoxic?)

1.        Confirm chest rise and bilateral breath sounds with each ventilation

2.        Check O2 source (trace from bag to flowmeter)

3.        Check mark for hypoxia  

Hydrogen Ion Acidosis (is this pt acidotic?) (Respiratory or metabolic?)

1.        Respiratory acidosis ensure adequate ventilation (don’t hyperventilate!)

2.        Metabolic acidosis give sodium bicarbonate

3.        Check mark for acidosis 

Hyper /Hypokalemia (is there any evidence hyper/hypokalemia in this pt?)

1.        For  elevated S-T’s and tall peaked T waves (hyperkalemia) give calcium chloride 10ml of 10% over 5 minutes

2.        Hypokalemia, flat Twaves, U waves? give potassium 20mmol

3.        Magnesium 5ml 50% solution (10mmol /over 30mins)

4.        If no signs of hyper/hypokalemia move to the next H

5.        Checkmark for hyper/hypokalemia

Hyper/Hypothermia (take a temp)

1.        If too hot, cool down

2.        If too cold, warm up

3.        If normothermic or mildly hypothermic

go to the next H.

4.    Check mark for Hyper/hypothermia

Hypo/Hyperglycemia

1.        Accu-check and correct if needed. 

2.        If normoglycemic move to the T’s Checkmark for Hypo/hyperglycemia

 
 

Tablets (drug OD, accidents)

Supp      1. Support circulation while you find an antidote or rever          reverse drug. (poison control)

2.                    2. If no drug OD suspected, move on to the next T. Check mark for tablets

Tamponade (chest trauma, chest malignancy, recent central line insertion, JVD, narrow pulse pressure, electrical alternans etc…)

1.  Pericardial centesis

2.                                If no history or ruled out move on to the next T and check mark for Tamponade

Tension Pneumothorax (chest asymmetry, tympani, diminished breath sounds, high peak pressures, JVD, tracheal deviation, severe respiratory distress etc…)

  1. Vent tension in chest
  2. Support ventilation and oxygenation with BVM and intubate as necessary
  3. If no history or ruled out move on to the next T and check mark for pneumothorax

Thrombosis (coronary or pulmonary)

  1. Consider fibrinolysis for suspected coronary or pulmonary embolus.
  2. CPR is not a absolute contraindication for fibrinolysis. 
  3. If no history or ruled out move on to the next T and check mark for  thrombosis

Trauma

  1. Inspect body completely.  Remove all clothes.
  2. Secure airway
  3. Control external bleeding with tamponade while concurrently delivering volume with isotonic crystalloids and blood products.
  4. Look for internal bleeding (tap the abdomen if suspicious for internal bleed)and take to

        OR within a couple of minutes. 

  1. If no history or ruled out move on to the next check mark for trauma
  2.  Etc…