TRAUMA CARDIAC ARREST
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive apneic patient with absent carotid pulses with a high suspicion of traumatic origin.
EMPHASIS ON PATIENT CARE
Effective CPR, ALS intervention, possible decision to terminate resuscitation
Verify that the mechanism of injury is consistent with the patient presentation and the cause of arrest
1. Primary Management - Assess X-ABC’s (hemorrhage control as priority) and manage as indicated.
a. C- spine precautions
b. Initiate CPR, ventilate with 100% OXYGEN.
2. Contact medical control if patient meets criteria for Termination of Resuscitative Efforts Guidelines.
3. Transport the patient as soon as possible to the nearest medical facility, consider ALS intercept if transport time > 10 minutes.
a. Insert airway (follow Airway Management Guidelines).
b. Turn the defibrillator/monitor on and apply defibrillation electrodes.
c. Analyze the ECG rhythm.
d. If patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.
4. For traumatic arrest deemed appropriate for transport, all interventions beyond CPR, and spinal restrictions should be performed in-route to receiving facility to minimize scene time. Assess risk of CPR in-route before initiating transport.
AEMT
5. In route, initiate two large bore IV or IO access lines administering an isotonic fluids (LR or NS).
PARAMEDIC
6. Place a Supraglottic Airway or ETT in accordance with the corresponding Airway Management Guidelines, allowing no disruption of chest compressions during placement. Managing the airway with BLS techniques is appropriate if good ventilation is achieved.
7. Consider reasons patient may be in arrest and rule out reversible causes.
8. If chest trauma suspected perform bilateral needle chest decompressions in the second intercostal space in the mid-clavicular line early in the resuscitation.
9. If patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.
10. Follow Termination of Resuscitation guidelines with on-line medical direction if needed.
11. H’s & T’s
Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hyper-/hypokalemia
Hypothermia.
Toxins
Tamponade (cardiac)
Tension pneumothorax
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms include an unresponsive apneic patient with absent carotid pulses with a high suspicion of traumatic origin.
EMPHASIS ON PATIENT CARE
Effective CPR, ALS intervention, possible decision to terminate resuscitation
Verify that the mechanism of injury is consistent with the patient presentation and the cause of arrest
1. Primary Management - Assess X-ABC’s (hemorrhage control as priority) and manage as indicated.
a. C- spine precautions
b. Initiate CPR, ventilate with 100% OXYGEN.
2. Contact medical control if patient meets criteria for Termination of Resuscitative Efforts Guidelines.
3. Transport the patient as soon as possible to the nearest medical facility, consider ALS intercept if transport time > 10 minutes.
a. Insert airway (follow Airway Management Guidelines).
b. Turn the defibrillator/monitor on and apply defibrillation electrodes.
c. Analyze the ECG rhythm.
d. If patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.
4. For traumatic arrest deemed appropriate for transport, all interventions beyond CPR, and spinal restrictions should be performed in-route to receiving facility to minimize scene time. Assess risk of CPR in-route before initiating transport.
AEMT
5. In route, initiate two large bore IV or IO access lines administering an isotonic fluids (LR or NS).
PARAMEDIC
6. Place a Supraglottic Airway or ETT in accordance with the corresponding Airway Management Guidelines, allowing no disruption of chest compressions during placement. Managing the airway with BLS techniques is appropriate if good ventilation is achieved.
7. Consider reasons patient may be in arrest and rule out reversible causes.
8. If chest trauma suspected perform bilateral needle chest decompressions in the second intercostal space in the mid-clavicular line early in the resuscitation.
9. If patient is in V-Fib or Pulseless V-Tach., follow Medical Cardiac Arrest Treatment Guidelines if arrest is not due to obvious trauma. Remember the arrest may have preceded trauma and may be the underlying cause.
10. Follow Termination of Resuscitation guidelines with on-line medical direction if needed.
11. H’s & T’s
Hypovolemia
Hypoxia
Hydrogen Ion (acidosis)
Hyper-/hypokalemia
Hypothermia.
Toxins
Tamponade (cardiac)
Tension pneumothorax