Trauma Cardiac Arrest Medical Directive

Question 1

What are the indications for the trauma cardiac arrest medical directive?

Answer 1

Cardiac arrest secondary to severe blunt or penetrating trauma.

Question 2

What are the indications for CPR?

Answer 2

LOA - Altered
Other - Performed in 2-minute intervals

Question 3

What are the indications for manual defibrillation?

Answer 3

Age ≥24 hours
LOA - Altered
Other - VF OR pulseless VT

Question 4

What are the conditions for a Trauma TOR?

Answer 4

Age ≥16 years
LOA - Altered
HR - 0
RR - 0
SBP - N/A
Other - No palpable pulses AND
No defibrillation delivered AND
Rhythm Asystole AND
No signs of life at any time since fully extricated OR
Signs of life when fully extricated with the closest ED ≥30 min
transport time away OR
Rhythm PEA with the closest ED ≥30 min transport time away.

Question 5

What are the contraindications for CPR?

Answer 5

Obviously dead as per BLS PCS
Meets conditions of the DNR Standard

Question 6

What are the contraindications for manual defibrillation?

Answer 6

Rhythms other than VF or
pulseless VT

Question 7

What are the contraindications for a trauma TOR?

Answer 7

• Age <16 years
• Defibrillation delivered
• Signs of life at any time since fully extricated medical contact
• Rhythm PEA and closest ED <30 min transport time away
• Patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital < 30 min transport time away

Question 8

What is the dosage for manual defibrillation for patients who are ≥24 hours to <8 years old?

Answer 8

2 J/kg, no dosing interval.
Max 1 dose

Question 9

What is the dosage for manual defibrillation for patients who are ≥8 years old?

Answer 9

Joules as per RBHP / manufacturer, no dosing interval.
Max 1 dose.

Question 10

What is the mandatory provincial patch point for the trauma cardiac arrest MD?

Answer 10

Patch to BHP for authorization to apply the Trauma TOR if applicable. If the BHP
patch fails, or the Trauma TOR does not apply, transport to the closest appropriate
receiving facility following the 1st analysis/defibrillation.

Question 11

What are the clinical considerations for the trauma cardiac arrest MD?

Answer 11

• If no obvious external signs of significant blunt trauma, consider medical cardiac arrest and treat according to the appropriate medical cardiac arrest directive.
• Signs of life: specifically any spontaneous movement, respiratory efforts, organized electrical activity on ECG, and reactive pupils.
• An intravenous fluid bolus may be considered, where it does not delay transport and should not be prioritized over management of other reversible pathology.