The 4H and 4T Pediatric Early Acute Support in the Deteriorating Child: Competent Staff Instead Experts Facing the New Threats, and New Approaches can Reduce Mortality—Experience in Guatemala

Abstract

Pediatric advanced life support courses provide widespread education on recognizing and treating cardiac arrest in children. Their main goal is to teach the Cardiopulmonary Resuscitation (CPR) sequence and improve early recognition and treatment of leading causes for better survival rates. Initially, there were four “H” and four “T” conditions, but now 12 are recognized. The 12 reversible conditions, categorized as “H’s” and “T’s,” consist of seven starting with “H” and five starting with “T.” The “H’s” include hypovolemia, hypoxia, hydrogen ion excess (acidosis), hypoglycemia, hypokalemia, hyperkalemia, and hypothermia. The “T’s” include tension pneumothorax, tamponade—cardiac, toxins, thrombosis (pulmonary embolus), and thrombosis (myocardial infarction). Finding specific training for these conditions in structured courses can be challenging. However, understanding their physiological basis enables healthcare providers to detect and treat them early, leading to improved outcomes and reduced mortality rates in Guatemala. In response to the COVID-19 outbreak, a regular course on managing these conditions was initiated for pediatric intensivists, pediatricians, and healthcare staff. In 2022, the Continuing Medical Education program at Universidad de San Carlos de Guatemala extended coverage to 134 physicians in rural areas and 50 pediatric intensivists from the Sociedad Latinoamericana de Cuidado Intensivo Pediátrico (SLACIP).