Trauma Arrest

Question 1

Are odds of surviving from cardiopulmonary arrest better for penetrating or blunt trauma?

Answer 1

Penetrating

Question 2

When should you not attempt to resuscitate a trauma patient?

Answer 2

When there is no chance of survival, when attempts and transport expose EMS and public to risks.

Question 3

What are the prehospital trauma arrest guidelines?
What are the categories within those guidelines?

Answer 3

National association of EMS physicians
American college of surgeons committee on trauma

Categories:
-resus withheld
-resus initiated
-resus terminated

Question 4

Resuscitation withheld

Answer 4

-no breathing, no pulse, no organized cardiac activity
-blunt trauma on EMS arrival
-penetrating trauma arrest
-no pupillary reflexes or spontaneous movement
-injuries incompatible for life
-evidence of significant time without pulse (dependant lividity, rigor mortis)

Question 5

What is a common cause of traumatic cardiopulmonary arrest?

Answer 5

Hypoxemia

Question 6

What causes hypoxemia?

Answer 6

Acute airway obstruction
Ineffective breathing

Question 7

What can accumulation from inadequate breathing contribute to in resus?

Answer 7

CO2 accumulation contributes to unsuccessful resuscitation.

Question 8

Causes of trauma arrest : airway problems

Answer 8

-foreign body
-tongue prolapse
-swelling
-tracheal damage
-hemorrhage into airway
-misplaced advanced airway

Question 9

Causes of trauma arrest: breathing problems

Answer 9

-tension pneumo+open pneumo
-flail chest
-pulmonary contusion
-high spinal cord injury
-carbon monoxide inhalation + smoke inhalation
-aspiration
-drowning
-CNS depression from drugs or alcohol
-apnea secondary to electrical shock or lightning strike

Question 10

Causes of trauma arrest: circulatory problems

Answer 10

-inadequate return of blood to the heart (hemorrhaging shock,
tension pneumothorax,
pericardial tamponade. )

-inadequate pumping of the heart
( myocardial contusion,
acute myocardial infarction,
cardiac arrest secondary to electric shock)

Question 11

Most cardiac arrest victims are….?

Answer 11

Young and have no pre-existing cardiac disease

Question 12

Trauma cardiac arrest: special groups

Answer 12

-Isolated head injury (extent not determined in field)

-massive blunt injury (resus withheld if found
asystolic)

Children
-aggressively attempt resuscitation (follow pals guidelines)

Drowning
-hypoxia

Question 13

Considerations in management of traumatic cardiac arrest?

Answer 13

General approach
-identify H’s & T’s
-control any exsangunating hemorrhage
-provide SMR if indicated
-ABC assessment
-Being good quality chest compression
-start monitoring
-prepare for immediate transport

Question 14

What are the H’s

Answer 14

-hypoxia
-hypovolemia
-Hydrogen ions (acidosis)
-Hypothermia
-hyperkalemia

Question 15

What are the T’s

Answer 15

-tension pneumothorax
-tamponade

Question 16

Airway Considerations in TCPA management

Answer 16

-optimal airway unclear
-prolonged periods of hypoxia
-risk of aspiration
-endotracheal vs supraglottic

Question 17

Breathing Considerations in TCPA management

Answer 17

-tube positioning
-tension pneumothorax
-open pneumothorax

Question 18

Ventilation Considerations in TCPA management

Answer 18

-PPV reduces. Venous. Return.
-avoid over ventilation
10-12/min With 5-8 mL/kg

Question 19

Capnography Considerations in TCPA management

Answer 19

-low CO2 indicates O2 in cells is low
-rising CO2 indicates improving circulation
-establish correct ventilatory rate

Question 20

Circulation Considerations in TCPA management

Answer 20

-control external hemorrhage
- IV access (Rapid 2 L of crystalloid)
-neck veins
-abdomen distension
-long bone fractures
-unstable pelvis
-electrical shock
-portable ultrasonography