Traumatic Arrest: Flashcards
What 5 things cause arrest following trauma:
Severe TBI/ high cervical transection
Airway obstruction
Tension pneumothorax
Pericardial tamponade
Hypovolaemia (haemorrhage)
—> incl. Aortic transection, haemothorax etc.
GENERAL APPROACH TO TRAUMATIC ARREST:
Management centres on:
1- restoring blood volume and
2- treating reversible causes (tension, tamponade, airway obstruction)
NOT:
-CPR
-Shocks
-Pressors
-Crystalloid
________________________________
- Activate: Trauma call, massive transfusion protocol
- Head at 30deg
- Spinal precautions
-
Seek and control haemorrhage:
—> Compress, bind, splint, elevate
—> TXA 1g IV
-IV access and BLOOD
-Bilateral finger thoracostomy
-Early FAST
—> ? Tamponade ?haemoperitoneum
-CONSIDER THORACOTOMY
PostROSC
-Tube and vent +- paralyse
-CT Trauma series
-2 survey
-Permissive hypotension
-Deadly triad: temp, coagulopathy, acidosis
Indications for RESUSCITATIVE thoracotomy:
Consider if:
1- Thoracic trauma (blunt or pen)
2- Arrest with recent signs of life (<10ish mins ago),
OR
Periarrest and tamponade seen on FAST
3- Absence of clear unsurviveable injury
4- Cardiothoracics available/nearby
Survival 5 - 35%
Best outcomes when:
- Penetrating thoracic injury
- Arrest <10mins ago
- Isolated injury
*’Signs of life’ includes PEA, pupillary response
Procedure: resuscitative thoracotomy
Brief the room
PPE
Rapid antiseptic wash
Should already have bilateral thorracostomies 5th IC/midaxillary.
Start with unilateral LEFT thoracotomy
- Extend thoracostomy along ribs to sternum
- Use rib spreader (ensure handle in axilla)
- Lift, snip and sweep pericardium avoiding phrenic nerve
- Deliver heart and inspect
- Consider clamping aorta
Extend to ‘clamshell’ if indicated
- Mirror incision on R side
- Shears or Gigli to cut horizontal
through sternum
- Reposition rib spreaders in midline
Consider:
-Hilar twist
-Control bleeders
-Crossclamp aorta
-Manual cardiac compressions
- Cannulate for bypass
-Internal defib 15J
