4 H’s 4 T’s Flashcards
List the 4 H’s
Hypoxia
Hypothermia
Hypovolemia
Hyper/Hypo - kalemia, natremia, metabolic
List the 4 T’s
Toxins
Tamponade
Tension Pneumothorax
Thrombosis
What causes hypoxia?
Pulmonary Embolism
Choking
Asphyxia (strangulation)
Drowning
Asthma
COPD
Anemia
Direct trauma to airway
Trauma or disease to central nervous system
What are the signs of hypoxia?
Low saturations
Cyanosis - peripherally & centrally
Caping (common for a PE)
Poor end tidal wave form
What rhythm is expected in a hypoxic cardiac arrest?
Initially PEA which progresses into asystole within minutes
How is hypoxia reversed?
Applying high flow oxygen & providing good ventilations
What may a good box form end tidal wave indicate?
A good box form wave maybe be low intra-arrest but should improve with hypoxia being reversed, this could indicate that a ROSC may be achieved.
What might a poor end tidal box form wave indicate?
A poor box form wave may indicate that the patient is receiving poor ventilation or poor CPR is being performed. It may also indicate that there is a reason hypoxia can not be reversed e.g. PE
What could be indicated if the end tidal took the form of a shark fin?
That the patient has COPD or asthma and is retaining CO2.
What causes hypothermia?
Prolonged exposure to cold weather or immersion of cold water and/or impaired thermoregulation. This causes a drop in core body temperature which results in failure of the cardiac and respiratory systems.
What changes during a hypothermic cardiac arrest?
Temperature under 30* - no drugs administered & maximum 3 shocks (drugs won’t metabolise)
Temperature 30-34* - the drug intervals are doubled (6-10 mins) (resus council)
Temperature 34+ - normal resuscitation protocols
Must be conveyed to hospital - unable to call recognise of life extinct in the community if hypothermia is the suspected cause
What rhythm is expected in hypothermic cardiac arrests?
Initially PEA progressing to asytole
How is hypothermia reversed?
Attempt to make the patient warm - blankets, warm environment, dry off if immersed in water, warmed fluids
Transport to hospital as soon as possible and unable to recognise of life extinct with hypothermic patients. Patients need to be warm and dead.
What are the signs of hypothermia?
Low temperature
Trismus - tight jaw muscles affecting ability to open mouth
Cyanosed
Grey
Environment exposure
What causes hypovolemia?
Loss of blood from trauma or injury (external - blood on the floor, internal - chest, abdomen, pelvis, long bones)
Loss of fluids (D+V) (sweating)
Severe burns
Vasodilation
How is hypovolemia reversed?
Stopping the bleeding - pressure, dressings, haemastatic gauze, tourniquets, pelvic binder, traction splints
TXA to aid clotting
Rapid infusion of fluids or blood products
Administer oxygen in attempt to prevent hypoxia
What rhythm is expected in a hypovolemic cardiac arrest?
PEA or asystole
What are the signs of hypovolemia?
Pre-arrest - tachycardia, tachypoenic, hypotension, cyanosed, LoC, dry skin or mouth, DiB, wide eyed
Intra-arrest - heart stops pumping and other organs stop functioning
What is hyper/hypokalemia, hypoglycaemia and hyponatremia?
These are all metabolic imbalances that can cause cardiac arrests.
Hyperkalemia - abnormally high potassium levels in the body can damage the heart and cause an MI progressing into a cardiac arrest
Hypokalemia - abnormally low potassium levels in the body can cause severe disturbance in the cardiac condition pathways
Hypoglycaemia - low blood sugar levels or being unable to metabolise sugar can cause unconsciousness leading to patients to stop breathing causing hypoxia
Hyponatremia - low sodium in the blood
How are metabolic imbalances reversed?
Hyperkalemia - administering sodium bicarbonate or calcium chloride
Hypokalemia - IV potassium
Hypoglycaemia - IV glucose
Hyponatremia - IV fluids
What rhythm is expected in a metabolic imbalance cardiac arrest?
VF or VT
What signs would indicate a metabolic imbalance cardiac arrest?
History of:
Diabetes
Potassium imbalance
DKA
Kidney issues
Dialysis
D&V - this can cause an electrolyte imbalance but can also cause hypovolemia
What causes toxins?
Intentional or accidental drug overdose of over the counter or recreational drugs.
Suspected poisoning - animals bites, no antidotes available pre-hospital
What are the signs of a toxin cardiac arrest?
Normally evidence based - environment, packaging, track marks, pupils.
Pin point pupils - opiates (heroin, codeine)
Dilated pupils - amphetamines (cocaine)
