Question

During cardiac arrest, the focus is on the cause of the event resulting in cardiovascular collapse. Describe the potential causes using the 5 H's and 5 T's associated with cardiac support. List the cause and describe the assessment used with each and the treatment associated.

Answer 1

Five ‘H’ are,

• HYPOVOLEMIA
• HYPOXIA
• HYDROGEN ION (ACIDOSIS)
• HYPER/HYPOKALEMIA
• HYPOTHERMIA

HYPOVOLEMIA

• Caused by the loss of fluid volume in the circulatory system
• Assessment is to look for the obvious blood loss
• Intervention includes to obtain IV access and administer IV fluids

HYPOXIA

• Caused due to deprivation of adequate oxygen supply, which can lead to cardiac arrest
• Examinations include check for cyanosis, difficulty in breathing
• Treatment part, ensure that the airway is open, ensure adequate ventilation and bilateral breath sounds

HYDROGEN ION (ACIDOSIS)

• Arterial blood gas analysis is recommended to determine respiratory acidosis
• Provide adequate ventilations, use sodium bicarbonate to prevent metabolic acidosis.

HYPER/HYPOKALEMIA

• Hyperkalemia is Caused by the taller pecked T Waves and the widening of QRS complex
• Hypokalemia is caused by the flattened t wave and the widening of QRS complex
• Never give Intravenous potassium

HYPOTHERMIA

• Caused due to exposure to cold
• Warming measures to be taken
• Raise core temperature above 86-degree F 30 degree C as soon as possible
• Patient may not respond to medicine during hypothermia

FIVE “T”

• TOXINS
• TAMPONADE
• TENSION PNEUMOTHORAX
• THROMBOSIS (HEART)
• THROMBOSIS(LUNG)

TOXINS

• Accidental overdose is the more common cause of toxins.eg: digoxin, betablockers
• Bradycardia, pupil symptoms are manifested
• Poison control can be utilized to obtain information about toxins and reversing agents

TAMPONADE

• Cardiac tamponade is an emergency condition in which, fluid accumulates in the pericardium. The buildup fluid results in the ineffective pumping of the blood which can lead to cardiac arrest
• Treatment recommended is pericardiocentesis

TENSION PNEUMOTHORAX

• Tension pneumothorax occurs when air is allowed to enter the pleural space and is prevented from escaping naturally. This leads to a build-up of tension that causes shifts in the intrathoracic structure that can rapidly lead to cardiovascular collapse and death.
• ECG signs include narrow QRS complexes and rapid heart rate. Physical signs include JVD, tracheal deviation, unequal breath sounds, difficulty with ventilation, and no pulse felt with CPR.
• Treatment of tension pneumothorax is needle decompression.

THROMBOSIS (HEART)

• Coronary thrombosis is an occlusion or blockage of blood flow within a coronary artery caused by blood that has clotted within the vessel. The clotted blood causes an acute myocardial infarction which destroys heart muscle and can lead to sudden death depending on the location of the blockage
• Treatments for coronary thrombosis before cardiac arrest include the use of fibrinolytic therapy, or PCI (percutaneous coronary intervention). The most common PCI procedure is coronary angioplasty with or without stent placement.

THROMBOSIS(LUNG)

• Pulmonary thrombus or pulmonary embolism (PE) is a blockage of the main artery of the lung which can rapidly lead to respiratory collapse and sudden death.
• Treatment includes surgical intervention (pulmonary thrombectomy) and fibrinolytic therapy.