In practice while performing CPR often in stressful situations, it is difficult to remember all 4 “Ts” and 4 “Hs” causes hypoxia,
- tension pneumothorax,
- tamponade
- thrombosis
- toxins
- hypoxia
- hypokalaemia/hyperkalaemia,
- hypothermia/hyperthermia
- hypovolaemia
especially for medical students, young doctors and doctors not experienced in CPR.
We would like to provide an approach used in our hospital for teaching and performing CPR. This approach helps to easily remember and make the diagnosis of 4 “Ts” and 4 “Hs”, just according to the general ABC rule:
A–secure airway
- hypoxia is treated by artificial ventilation
B–secure breathing symmetrical on both sides of thorax
- tension pneumothorax must be treated
C–secure circulation– point of care echocardiography plays critical role in diagnosis:
- hypovolemia – represented by small/collapsed inferior vena cava and “empty” heart (end diastolic diameter of left ventricle below 35mm)
- pulmonary embolism represented by dilated right ventricle, which is bigger then left ventricle
- thrombosis of coronary artery represented by hypokinetic left ventricle/fibrillation
- tamponade represented by fluid in the pericardium compressing the heart
Those six causes can be treated during CPR without established intravenous access.
Check for two metabolic causes, which can be diagnosed only after blood sample is obtained and analysed for:
- kalaemia (hyperkalaemia/hypokalaemia)
- hydrogen ion (acidosis)
Check for two relatively rare causes, which require specific treatment:
- hypothermia/hyperthermia
- toxicity
https://www.resuscitationjournal.com/article/S0300-9572(18)30123-0/fulltext