Reversible Causes of Cardiopulmonary Arrest

Aka: Reversible Causes of Cardiopulmonary Arrest, 5H5T, 6H6T, Never Carry Bling Through Gloomy Antwerp Mnemonic, Empiric Measures to Consider in Cardiac Arrest

II. Conditions

  1. Cardiopulmonary Arrest
  2. Arrhythmia
  3. Pulseless Electrical Activity
  4. Ventricular Tachycardia
  5. Ventricular Fibrillation
  6. Supreventricular Tachycardia

III. Background

  1. Mnemonic: 6H 6T

IV. Causes: Six H's

  1. Hypovolemia
  2. Hypoxia
  3. Hydrogen Ion (Metabolic Acidosis)
  4. Hyperkalemia
  5. Hypokalemia
  6. Hypothermia

V. Causes: Six T's

  1. Tablets or Toxins (Unknown Ingestion)
    1. Tricyclic Antidepressant Overdose
    2. Digitalis Toxicity
    3. Beta Blocker Overdose
    4. Calcium Channel Blocker Overdose
  2. Tamponade (Cardiac Tamponade)
  3. Tension Pneumothorax
  4. Thrombosis: Myocardial Infarction
  5. Thrombosis: Pulmonary Embolism
  6. Trauma

VI. Causes: Other

  1. Subarachnoid Hemorrhage (5% of Cardiac Arrests)
    1. Cardiac Arrest triggered by Catecholamine surge with Macrophage infiltration into left ventricle

VII. Management: Empiric Therapies

  1. Six empiric therapies to consider in Cardiac Arrest
  2. Mnemonic: "Never Carry Bling Through Gloomy Antwerp"
    1. Needle
      1. Emergency Pericardiocentesis (Cardiac Tamponade)
      2. Needle Thoracostomy (Tension Pneumothorax)
    2. Calcium
      1. Calcium Chloride stabilizes Myocardium (e.g. Hyperkalemia)
    3. Blood (or fluid Resuscitation)
      1. NS or LR bolus (Hypovolemic shock)
    4. Thrombolytics (e.g. tPA 50 mg)
      1. Massive Pulmonary Embolism
    5. Glucose
      1. See Hypoglycemia Management
    6. Antidote
      1. See Toxin Antidote
  3. References
    1. Strayer in Herbert (2015) EM:Rap 15(8): 4-5

VIII. References: Cardiopulmonary Resuscitation Guidelines

  1. http://www.circulationaha.org
  2. (2010) Guidelines for CPR and ECC [PubMed]
  3. (2005) Circulation 112(Suppl 112):IV [PubMed]
  4. (2000) Circulation, 102(Suppl I):86-9 [PubMed]

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