Tap a cause to see what to check & do
The 6 H's
Hypoxia
Maximise oxygen. Confirm ETT position and bilateral air entry; ventilate effectively.
Hypovolaemia
IV/IO fluid bolus 10–20 mL/kg. Control haemorrhage; consider blood if bleeding.
Hydrogen ion (acidosis)
Ensure effective ventilation and treat the cause. Sodium bicarbonate only if prolonged arrest or known metabolic acidosis / hyperkalaemia.
Hypo / Hyperkalaemia & metabolic
Check ABG, electrolytes, glucose. Hyperkalaemia: calcium, bicarbonate, insulin–dextrose, salbutamol.
Hypoglycaemia
Check blood glucose. Give Dextrose 10% 5 mL/kg (0.5 g/kg) if low.
Hypothermia
Check core temperature. Active rewarming; continue resuscitation until warm ("not dead until warm and dead").
The 5 T's
Tension pneumothorax
Absent breath sounds, tracheal shift. Needle decompression (2nd ICS, mid-clavicular line), then chest drain.
Tamponade (cardiac)
Muffled heart sounds, distended neck veins. Echo if available; pericardiocentesis.
Toxins
Consider ingestion / overdose. Specific antidote (e.g. naloxone for opioids); call poison centre.
Thrombosis — pulmonary (PE)
Consider in sudden collapse with risk factors. Thrombolysis if strongly suspected.
Thrombosis — coronary
Rare in children; consider with cardiac history or Kawasaki disease.
MR SOPA — bag-mask ventilation not working
Mask seal · Reposition airway · Suction mouth/nose · Open mouth · Pressure increase · Airway (LMA/ETT)
DOPE — intubated patient suddenly deteriorates
Displacement of tube · Obstruction (secretions/kink) · Pneumothorax · Equipment failure (circuit, O₂, bag)