H's & T's Algorithm

How do you identify hypovolemia

Rapid heart rate and narrow QRS on ECG; other symptoms of low volume

How do you treat hypovolemia

Infusion of normal saline or Ringer’s lactate

How do you identify hypoxia

Slow heart rate

How do you treat hypoxia

Airway management and effective oxygenation

how do you identify Hydrogen ion (acidosis)

Low amplitude QRS on the ECG

how do you identify Hypokalemia

Flat T waves and appearance of a U wave on the ECG

how do you treat hydrogen ion (acidosis)

Hyperventilation; consider sodium bicarbonate bolus

how do you treat hypokalemia

IV Magnesium infusion (

how do you identify Hyperkalemia

Peaked T waves and wide QRS complex on the ECG

how do treat hyperkalemia

Consider calcium chloride, sodium bicarbonate, and an insulin and glucose protocol

how do you identify Hypothermia

Typically preceded by exposure to a cold environment

how do you treat hypothermia

Gradual rewarming

how do you identify Tension pneumothorax

Slow heart rate and narrow QRS complexes on the ECG; difficulty breathing

how do you treat tension pneumothorax

Thoracostomy or needle decompression

how do you identify cardiac tamponade

Rapid heart rate and narrow QRS complexes on the ECG

How do you treat cardiac tamponade

Pericardiocentesis

How do you identify toxins

Typically will be seen as a prolonged QT interval on the ECG; may see neurological symptoms

How do you identify Thrombosis (pulmonary embolus)

Rapid heart rate with narrow QRS complexes on the ECG

How do you treat pulmonary thrombosis

Surgical embolectomy or administration of fibrinolytics

How do you identify Thrombosis (myocardial infarction)

ECG will be abnormal based on the location of the infarction