The H and T's are mnemonics that are used to help remember the possible causes of reversible heart attacks. Various disease processes can cause heart attacks; However, they usually boil down to one or more of "H and T".
Video Hs and Ts
H's
Hipovolemia
Lack of circulation of body fluids, especially blood volume. This is usually (though not exclusively) caused by some form of bleeding, anaphylaxis, or pregnancy with a gravid uterus. Treatment of peri-caps includes the administration of IV fluids and blood transfusions, as well as control of sources of bleeding - with direct pressure for external bleeding, or emergency surgical techniques such as the esophageal tape, gastroesophageal balloon tamponade (for the treatment of massive gastrointestinal bleeding as in esophageal varicose veins), thoracotomy in cases penetrating trauma or significant shear force applied to the chest, or exploratory laparotomy in cases of penetrating trauma, spontaneous rupture of the major blood vessels, or rupture of the perforated viscus in the abdomen.
Hypoxia
Lack of oxygen delivery to the heart, brain and other vital organs. A rapid assessment of airway patency and respiratory effort should be undertaken. If the patient is mechanically ventilated, the sound of breath and proper placement of the endotracheal tube should be verified. Treatment may include providing oxygen, good ventilation, and good CPR techniques. In case of carbon monoxide poisoning or cyanide poisoning, hyperbaric oxygen can be used after the patient is stabilized.
Hydrogen ion (acidosis)
Abnormal PH in the body due to lactic acidosis occurring in prolonged hypoxia and in severe infection, diabetic ketoacidosis, renal failure leading to uremia, or ingesting toxic agents or overdose of pharmacological agents, such as aspirin and salicylate, ethanol, ethylene glycol and other alcohols, tricyclic antidepressants, isoniazid, or iron sulfate. These can be treated with good ventilation, good CPR techniques, buffers such as sodium bicarbonate, and in some cases may require emerging hemodialysis.
Hyperkalemia or hypokalemia
Both the advantages and the lack of potassium can be life-threatening.
The general presentation of hyperkalemia is in patients with end-stage renal disease who have missed a dialysis appointment and present with extensive weakness, nausea, and QRS complexes on the electrocardiogram. (It should be noted that patients with chronic kidney disease are often more tolerant of high potassium levels because their bodies often adapt to them.) Some drugs, such as trimethoprim/sulfamethoxazole antibiotics or ACE inhibitors, can also lead to significant development of hyperkalemia.. The electrocardiogram will show a high, peaked T wave (often larger than the R wave) or it can turn into a sine wave as the QRS complex widens. Direct initial therapy is the administration of calcium, either as calcium gluconate or calcium chloride. This stabilizes the electrochemical potential of the cardiac myocytes, thereby preventing the development of fatal arrhythmias. However, this is only a temporary measure. Other temporary measures may include salbutamol nebulisation, intravenous insulin (usually given in combination with glucose), and all sodium bicarbonate while temporarily moving potassium into the cells. Definitive treatment of hyperkalemia requires true urinary excretion of potassium, either through urine (which can be facilitated by administration of a diuretic loop like furosemide) or in stool (achieved by administering sodium polystyrene sulphonate enteral, where it binds potassium in the GI of the channel.) Severe cases will require emerging hemodialysis.
Diagnosis of hypokalemia (not enough potassium) can be suspected when there is a history of diarrhea or malnutrition. Loop diuretics can also contribute. The electrocardiogram may indicate the flattening of T waves and prominent U waves. Hypokalemia is an important cause of long-term QT ​​syndromes acquired, and may affect patients to perform torsades de pointes. Digital use may increase the risk that hypokalemia will produce life-threatening arrhythmias. Hypokalemia is very dangerous in patients with ischemic heart disease.
Hypothermia
A low core body temperature, defined clinically as a temperature of less than 35 degrees Celsius (95 degrees Fahrenheit). The patient is warmed again either by heart bypass or by irrigation of the body cavity (such as thorax, peritoneum, bladder) with warm fluid; or warm IV fluids. CPR is only given until the core body temperature reaches 30 degrees Celsius, because defibrillation is not effective at lower temperatures. Patients have been known to be resuscitated after several hours in hypothermia and heart attacks, and this has led to a frequently quoted medical truism, "You do not die until you are warm and dead."
Maps Hs and Ts
T's
Tablet or poison
Tricyclic antidepressants, phenothiazines, beta blockers, calcium channel blockers, cocaine, digoxin, aspirin, paracetamol/acetophenophen. This can be proved by items found in or around the patient, the patient's medical history (ie drug abuse, medication) taken from family and friends, checking medical records to ensure no prescribed medications are interacted, or sending blood and urine samples to the toxicology lab for reports. Treatment may include special antidote, fluids for volume expansion, vasopressor, sodium bicarbonate (for tricyclic antidepressants), glucagon or calcium (for calcium channel blockers), benzodiazepines (for cocaine), or cardiopulmonary bypass. Herbal supplements and over-the-counter medicines should also be considered.
Tamponade heart
Blood or other fluid formed in the pericardium can put pressure on the heart so it can not beat. This condition can be identified by a narrowed pulse pressure, muffled heart sound, protruding neck veins, electrical alternation to the electrocardiogram, or by visualization of the echocardiogram. It is treated in an emergency by inserting a needle into the pericardium to drain the fluid (pericardiocentesis), or if the liquid is too thick then the subxiphoid window is performed to cut the pericardium and release the liquid.
Tension pneumothorax
The buildup of air into one of the pleural cavities, which causes a mediastinal shift. When this happens, the large vessels (especially the superior cava vein) become flexed, which restricts blood back to the heart. This condition can be identified by severe air hunger, hypoxia, jugular venous distension, hypersensonance to percussion on the diseased side, and tracheal shift from the affected side. Tracheal shifts often require a chest x-ray to appreciate (although treatment should be initiated before getting chest x-rays if this condition is suspected). This is relieved by a thoracotomy needle (inserting a needle catheter) into the second intercostal space on the mid-clavicle line, which reduces the pressure in the pleural cavity.
Thrombosis (myocardial infarction)
If the patient can be successfully resuscitated, it is possible that myocardial infarction may be treated, either with thrombolytic therapy or percutaneous coronary intervention.
Thromboembolism (pulmonary embolism)
A hemodynamically significant pulmonary embolism is generally large and usually fatal. Thrombolytic administration may be tried, and some specialized centers may perform thrombectomy, but the prognosis is generally poor.
Trauma
Cardiac arrest can also occur after a hard blow to the chest at the right moment in the cardiac cycle, known as commotio cordis. Other traumatic events such as high-speed car accidents can cause sufficient structural damage to trigger an arrest.
Item removed from list
Hypoglycemia
There is an uncertain link between hypoglycemia and sudden cardiac death. In the NICE-SUGAR trial, moderate and severe hypoglycaemia were both associated with increased mortality. However, dextrose administration is also associated with poor outcomes.
Hypoglycemia has been removed from H and T by the American Heart Association in their ACLS 2010 update.
References
Source of the article : Wikipedia
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