Reversible causes Flashcards
List the 4Hs
Hypovolaemia
Hypo/hyperkalaemia or other metabolic disorders
Hypo/hyperthermia
Hypoxia
List the 4Ts
Tension Pneumothorax
Tamponade
Toxins
Thrombus (coronary/pulmonary)
List the 4Hs and 4Ts
Hypovolaemia
Hypo/hyperkalaemia or other metabolic disorders
Hypo/hyperthermia
Hypoxia
Tension Pneumothorax
Tamponade
Toxins
Thrombus (coronary/pulmonary)
For hypovolaemia discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
- Clinical signs of low CO
- Active bleeding/fluid losses
Possible causes:
- haemorrhage
- distributive shock (sepsis/anaphylaxis)
Treatment:
- Blood transfusion
- IVF boluses
- Treat cause of haemorrhage
For hypokalaemia discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
VBG: K+ <3.5
Possible causes:
- drugs
- GI/renal loss
- poor PO intake
Treatment:
- K+: KCl 5-10mmol push if in arrest
KCl 10mmol infusion over 30-60 minutes if not in arrest
- MgSO4
For hyperkalemia discuss:
- Evaluation
- Treatment
Evaluation:
VBG: K+ > 6.5
ECG changes: peaked T waves
Treatment:
- Calcium gluconate/ calcium chloride
- Glucose / actrapid infusion
- Sodium bicarbonate in severe acidosis/renal failure
For other metabolic disorders discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
BSL <4.0 (hypoglycaemia)
Altered LOC
Possible causes:
- diabetes
- starvation
Treatment:
- 25-50mL 50% dextrose IV push
For hypothermia discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
T < 35.5
Possible causes:
- drowning
- exposure to cold environments
- infection (cold sepsis)
Treatment:
- bair-hugger
- blankets
- heat packs
- sepsis MX (ivabx, IVF)
For hyperthermia discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
T >40.0
Possible causes:
- heat exhaustion/heat stroke
- exposure to hot environments
- malignant hyperthermia (2o to drugs such as MDMA, ecstasy and amphetamines)
Treatment:
- cool packs
- removing layers
For hypoxia discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
Spo2 < 90%
Clinical signs of hypoxia
Possible causes:
- decreased LOC 2o to trauma/drugs/severe respiratory illnesses
- apnea
Treatment:
- O2
For tension pneumothorax discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
Shifted trachea
Clinical signs of hypoxia
Possible causes:
- Thoracic trauma/recent surgery
- Asthma/COPD
Treatment:
- Needle thoracocentesis
14G PIVC 2nd ICS @ MCL
For tamponade discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
Bedside echo
Clinical signs of cardiovascular collapse
Chest pain
Possible causes:
- Thoracic trauma/recent surgery
- CVADs
- Recent cardiovascular events (MI/PCI or angio/pericarditis)
Treatment:
- Fluid resuscitation
- USS guided pericardiocentesis/thoracotomy or OT
For thrombosis discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation:
Coronary: cardiac chest pain, ECG changes
Pulmonary: pleuritic chest pain, ECG changes
Fat: recent orthro trauma/surgery
Treatment: ACS: aspirin 300mg PO, GTN sublin spray, O2, morphine Cardiology review Fibrinolytic therapy Angio --> PCI
For toxins discuss:
- Evaluation
- Possible causes
- Treatment
Evaluation: Altered LOC Ambulance report Clinical signs of sepsis Clinical signs of anaphylaxis
Possible causes:
Intentional/accidental OD
Infection
Exposure to allergen
Treatment: As per TOXINZ Opioids: naloxone 400mcg IV (up to 1.2g) Tricyclic antidepressants: sodium bicarbonate 1mmol/kg Digoxin: digoxin antagonist Sepsis: IVF + IVABx Anaphylaxis: 0.5mg IMI adrenaline
