Traumatic Arrest

Question 1

Traumatic Arrest - Definition

Answer 1

A group of conditions precipitated by trauma causing loss of pulse respiration and signs of life

Question 2

Goals of Care

Answer 2

Rapid transport to ED for management of

• Airway emergencies, tension pneumothorax/flail chest/ open chest wound and tx of hypovolemia
• Recognition of which pts should not have resuscitation started in the field
• Recognizing when on going resuscitation is futile and should be terminated in the field
• Recognizing special circumstances i.e -
  1) medical cardiac arrest pt who then sustained some trauma
  2) electric shock
  3) hypothermia
  4) minor direct blunt trauma to the chest induced cardiac arrest (commotio cordis)

Question 3

Overview

Answer 3

It is important to approach this differently from ‘cardiac arrest’ as cardiac causes are unusual in the trauma situation

The pre-hospital focus of treatment and the outcomes are different between traumatic arrest and medical arrest w/ minor associated trauma

Massive, rapid blood loss and massive head injury will not respond to CPR and out of hospital treatments

Question 4

Special Note 1

Answer 4

The challenge for paramedics is to recognize that on rare occasions, the arrest is not due to massive head injury or blood loss and treatment is necessary

Question 5

Traumatic Arrest Guidelines - Discontinue in Obvious Death

Answer 5

• Transsection
• Decapitation
• Incineration
• Open skull fracture w/ exposed brain matter

Question 6

Identify Treatable Causes

Answer 6

• Tension pneumothorax
• hypovolemia
• Cardiac tamponade

Question 7

Blunt Traumatic Arrest

Answer 7

Review the hx of the event carefully.
It is sometimes difficult to determine if a medical event preceded the trauma orif the trauma resulted in the arrest

With signs of major trauma and absence/loss of pulse and respiration, you are likely dealing w/ a non-survivable situation

Contact Clinicall for likely d/c orders

With lower force trauma, consider medical diagnosis for the event

Question 8

Penetrating Traumatic Arrest

Answer 8

This is a special situation where there may be a surgically correctable bleeding site if direct control is quickly possible

**If you are within 15mins anticipated time from loss of pulse/respiration to the ED then rapid transport and notification is indicated

If time delay is greater than 15 mins contact CliniCall for likely d/c order

Question 9

Special Note 2

Answer 9

Though a difficult decision, in both cases if you are unable to reach CliniCall and you are greater than 15mins to the ED you should d/c resuscitation

Question 10

Intervention Guidelines - EMR/PCP

Answer 10

EMR

• Discontinue in Obvious Death
• Assess degree of injury and mechanism
• Ensure open airway and provide ventilations

Low energy blunt trauma
- CPR according to medical guidelines

High energy blunt trauma

Penetrating trauma
- CPR and immediately prepare for rapid transport, if <15mins from of LOSS of PULSES to ED arrival
otherwise CPR and contact CliniCall for likely d/c orders
- Control life threatening bleeding whhile facilitating transport
- Direct pressure to sites of obvious ongoing blood loss
- Rapid application of tight tourniquet for catastrophic extremity injury w/ ongoing large volume blood loss

PCP
All above, plus
IV therapy
- Fluid challenge up to 2L

Question 11

Intervention Guidelines - ACP

Answer 11

Assess for pneumothorax
- Depcompress the chest w/ needle thoracentesis

Consider advanced airway management en route

Question 12

Further Care

Answer 12

• Advanced diagnostics
• Central IV access
• Blood, IV pressors
• Chest tube
• Pericardiocentesis, thoracotomy
• OR/Surgery