When a patient remains in PEA or asystole despite high-quality CPR and Epinephrine, the team must identify and reverse the underlying physiological causes.
The 5 H's
- Hypovolemia: Severe fluid/blood loss. Correct with rapid crystalloid or blood infusion.
- Hypoxia: Lack of oxygen. Correct with ventilation and airway placement.
- Hydrogen Ion (Acidosis): Metabolic acidosis. Correct with hyperventilation and Sodium Bicarbonate.
- Hypo-/Hyperkalemia: Potassium imbalances. Correct with calcium chloride, insulin, dextrose, or potassium replacement.
- Hypothermia: Low body core temperature. Correct with active rewarming.
The 5 T's
- Tension Pneumothorax: Air trapped in pleural space. Treat with needle decompression and chest tube insertion.
- Tamponade (Cardiac): Fluid buildup in pericardial sac. Treat with pericardiocentesis.
- Toxins: Accidental overdose (tricyclics, beta-blockers, opioids). Treat with specific antidotes.
- Thrombosis (Pulmonary): Pulmonary embolism. Treat with fibrinolytic therapy.
- Thrombosis (Coronary): Myocardial infarction. Treat with angioplasty or thrombolytics.
