H’s and T’s of ACLS

Posted by Adam Rapp | ACLS

Feb 18, 2019

Identifying the most common causes of cardiac arrest and how to properly treat them.


The H’s and T’s are a mnemonic used to help remember the causes of cardiac arrest that are most frequently seen in patients experiencing heart failure. Because these underlying are oftentimes reversible, the ability to identify what contributed to an arrhythmia, and then following the proper steps to treat that particular cause is a critical aspect of Advanced Cardiac Life Support (ACLS) training.

  

The H's and T's of ACLS | eMedCert

  

Although the H’s and T’s are primarily associated with pulseless electrical activity (PEA), they can also be the cause of asystole, ventricular fibrillation (VF), and ventricular tachycardia (VT). It’s important to utilize the patient’s medical history, ECG, and any environmental or situational clues to help diagnose and treat the patient in order to increase the likelihood of a successful outcome (Return of Spontaneous Outcome or ROSC).

  

The H’s of ACLS:

  

Hypovolemia

What is it?

- A sudden and significant decrease in the volume of blood and fluids in your body

What causes it?

- Loss of blood (internal or external)

- Inadequate fluid intake

- Excessive diarrhea or vomiting

How to treat it?

- Obtain IV/IO access

- Administer fluids/blood products


Hypoxia

What is it?

- When the body is deprived of sufficient oxygen supply

What causes it?

- Lack of oxygen (due to high altitude, fire, drowning, etc.)

- Lung disease

- Chemical or gas poisoning

How to treat it?

- Ensure airway is open

- Increase oxygen intake

- Ventilate/intubate


Hydrogen Ions (Acidosis)

What is it?

- Improper pH level caused by too much acid (lactic acidosis) in the body

  What causes it?

- Respiratory: lung disease, buildup of carbon dioxide, etc.

- Metabolic: DKA/AKA, cancer, liver failure, etc.

  How to treat it?

- Respiratory: ventilate

- Metabolic: sodium bicarbonate


Hyper / Hypokalemia (Potassium)

What is it?

- Too much (hyperkalemia) or too little (hypokalemia) potassium in the body

What causes it?

- Kidney disease/failure

- Diuretics

- DKA

How to treat it?

- Hypokalemia: potassium (rapid infusion)

- Hyperkalemia: calcium chloride, sodium bicarbonate, dialysis


Hypothermia

What is it?

- When the body loses the ability to keep itself warm. By definition, hypothermia occurs when body temperature drops below 95˙ F (35˙ C)

What causes it?

- Extreme and/or prolonged exposure to cold weather and/or water

How to treat it?

- Passive and active warming measures to restore body to normal temperature


The T’s of ACLS:

  

Tension Pneumothorax

What is it?

- When air enters the pleural space but is unable to exit, causing a buildup in the pleural space

What causes it?

- Mechanical ventilation

- Chest trauma

How to treat it?

- Needle decompression


Tamponade (Pericardial Tamponade)

What is it?

- Buildup of blood or fluid in the pericardial space

What causes it?

- Chest trauma

- Myocardial rupture

- Pericarditis

How to treat it?

- Pericardiocentesis


Toxins

What is it?

- Intentional or accidental overdose

What causes it?

- Street drugs (overdose)

- Prescription or CTC drugs (overdose)

- Chemical exposure

How to treat it?

- Specific antidote based on overdose agent

- Support circulation


Thrombosis (Pulmonary Embolus)

What is it?

- Blockage of the lung’s main artery (pulmonary artery)

What causes it?

- Blood clot(s)

- Pulmonary embolism

How to treat it?

- Fibrinolytics

- Thrombolytics

- Embolectomy


Thrombosis (Acute Coronary Syndrome)

What is it?

- Blockage of the heart’s coronary artery/arteries

What causes it?

- Blood clot(s)

- Myocardial infraction

How to treat it?

- Fibrinolytics

- Percutaneous coronary intervention (PCI)


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