5 H's and 5 T's — PEA arrest reversibles
Reversible causes during PEA / asystole
Mnemonic device
5H + 5T
Mapping
H1
Hypovolemia — give fluid; look for bleeding
H2
Hypoxia — secure airway, 100% FiO2
H3
Hydrogen ion (acidosis) — ventilate, consider bicarb
H4
Hyper/Hypokalemia — calcium, insulin/glucose, bicarb if hyperK
H5
Hypothermia — active rewarming, especially before terminating
T1
Tension pneumothorax — needle decompress 2nd ICS midclav (or 4th-5th anterior axillary)
T2
Tamponade (cardiac) — pericardiocentesis
T3
Toxins — narcan (opioids), bicarb (TCA), lipid emulsion (LAST)
T4
Thrombosis (pulmonary) — PE → tPA if confirmed
T5
Thrombosis (coronary) — STEMI → cath lab post-ROSC
Clinical note: ACLS expects you to address all 10 cyclically during pulseless arrest. Bedside ultrasound speeds detection of tamponade, tension pneumo, RV strain.