all right in this video we're going to take a look at how to correct the HS and T's we'll also go over a quick review of what the HS and T's are and essentially what we can do to manage them so first things first the ages of ACLs care are hypovolemia hypoxia or hypoxemia hypo and hyper Alenia hydrogen ion passive doses and hypothermia the T's of ACLs care tamponade toxins tension pneumos and then pulmonary and cardiac thrombosis so when you look at the ages of ACLs we want you to remember invoke at the o ka T and we should preface this by saying always follow your local protocols so the first vivo canna want to look at is hypovolemia so a type of anemia you're gonna look for signs of tachycardia a narrow QRS and then blood loss which can be obvious or suspected so our treatment hypovolemia is typically going to be centered around replacing fluid levels keeping the patient warm and transporting them to the hospital second is the o invoke at and that stands that represents a hypoxia and hypoxemia the signs and symptoms of these things can be afraid of cardio's cyanosis of the lips fingers toes and ears and the treatment is providing oxygen and helping them mentally if they are doing it for themselves already so good bag-valve-mask ventilations a high flow oxygen pretty self-explanatory on this one but we want to make sure we're doing the basics very very well the K info cat stands for hypokalemia and hyperkalemia with hypo or low potassium we're gonna see flat t-waves and a possible you wave we'll look at some EKGs here in a second we're not really gonna have much to do in the pre-hospital setting in terms of treatment for this it's one of those more difficult ones I've had to draw some blood labs on to confirm and then give IV potassium some protocols will allow for lactated ringers to be given if that's in their suite of drugs that the agency uses and then hyperkalemia or too much potassium you'll see a peaked t-waves wide QRS and we'll go over an EKG to that in just a second here treatment is going to be again it's gonna vary depending on your protocols but people will see sodium bicarb as a treatment calcium IV calcium long term knab's to kind of pull the potassium back out of the cells and into the bloodstream and we'll go over those EKGs here real quick okay so first with hypokalemia we're gonna see flat t-waves so you can see these are relatively flat and a few of these leaves and then you're also gonna notice the potential for a u wave and the u wave is popping up in a couple spots but again this is kind of difficult to see because this is a physical tracing over a really light ECG that we had found and then with hyperkalemia again you're gonna see stages of hyperkalemia but you'll see these tall peaked t-waves and these are pretty pronounced these are let me know that this is maybe beyond the initial ages of hyper comedian next you'll go and see with hyper clean me you'll see a widened QRS and a lack of a sinus p-wave and this is going to be a later sign of hyperkalemia this has been going on for a while and it's really starting to affect this person's ECG rhythm so that a invoke at is acidosis or hydrogen ion excess and so we'll see a low amplitude QRS complex and again treatment for this typically going to be supportive care in the pre-hospital setting but you can see that these QRS is are pretty low in terms of amplitude they're about just over a box nothing too too large there and you can also see that this rather than a little bit irregular which is also common to see a witness with hydrogen ion excess that there's been going on for a while starting to affect the ECG rhythm and lastly is the T in boquete and that stands for hypothermia and so with these you'll get obviously you know you're gonna have someone that's in a coal pit in a cold environment for a very long time you want to get them out of that environment warm them up covered in love and blankets and then make sure that you do that in a controlled manner that isn't you know going to warm them up too quickly because that can cause problems in and of itself but one of the things we're looking for on the ECG with hypothermia is what's called Osborn waves and there are these little bumps here at the end of the QRS so a treatment for this is like we mentioned get them out in the environment give them some dry clean blankets to keep them warm and do that in a controlled manner so that we're not doing it too quickly all right moving on to the T's of ACLs wanting to remember a mnemonic tam talks ten from again always follow your local protocols but now this information will help you kind of clue into some things that you can do with the or treatment of the HSE T's so first Tam so that's cardiac tamponade and the signs with this with Beck's triad tachycardias JB's muffled heart tones and low blood pressure and look for a narrow QRS treatment for this is going to depend on your local protocols and most often we're going to be treating with some fluids making sure that we get the BP in a stable zone right around 90 systolic we'll be checking heart tones as well as providing supplemental oxygen and getting them to the hospital as quickly as possible tox is next or tucson's and with these we're looking for a prolonged QT interval or something that the patient is ingested that is potentially causing a little elongated QT interval so here's the start of this QT here all rights are the Q wave here and here is the T wave that is obviously a lot larger than it should be looks like it's about three boxes and we want to see that under two if I'm setting talked about big boxes here obviously next it's ten or tension pneumothorax and signs that are bradycardia and look for a narrow QRS you can have unequal breathing jvd and tracheal deviation is a late sign but with these we're looking for we're looking to provide supplemental oxygen and then decompress in the chest once it's developed from a pneumo to a tension pneumothorax and be sure to check out our video on tension pneumothorax management as well it lastly is throm or thrombosis again we have pulmonary and cardiac so we'll go over both here you have tachycardia primarily just due to the heart trying to work harder to get that little bit of oxygen it has left around to all the parts of the body that need it it will look for a narrow QRS you typically won't see my QRS is with these rhythms that's more of a late sign where some bad things have already been put into play for quite a while now you'll see shortness of breath low oxygen saturations and even chest pain if the patient's conscious and complained of anything they might actually point to where they're feeling pinpoint type chest pain and with this we're doing supportive care we're taking care of doing pain management providing supplemental oxygen and ventilations if need be and we're potentially providing some fluids to keep their blood pressure to healthy rate and to mainly get them the oxygen they need so that they can at least we can't be support them in wrap to the hospital and the lastly is coronary thrombosis you're gonna see a wide range of abnormal ECG findings here this one is obviously shown at a 12-lead of an MI going on you see lots of ST elevation which obviously signifies injury infarct to the heart and looks like this provider also circled the fact this is a left axis deviation just again supporting the fact that they're probably looking at a mi lots of things you'll see here with the coronary thrombosis but treatment is going to be typically pain management supportive oxygen nitroglycerin if it's in your protocols as well as providing aspirin as early on as as possible