Traumatic cardiorespiratory arrest

Question 1

Which outcome is better in traumatic cardiorespiratory arrest?

Answer 1

Very high mortality but if ROSC is achieved there is favourable neurological outcomes

Question 2

What are the causes of cardiac arrest in trauma patients?

Answer 2

• severe traumatic brain injury
• hypovolaemia from massive blood loss
• hypoxia from respiratory arrest or airway obstruction
• direct injury to vital organs and major vessels
• tension pneumothorax
• cardiac tamponade

Question 3

what is the prevalent rhythm in traumatic cardiac arrest?

Answer 3

asystole and PEA

Question 4

What is commotio cordis?

Answer 4

actual or near cardiac arrest caused by a blunt inpact to the chest wall

this usually happens to males

most commonly occurs in sports- baseball and recreational activity

Question 5

What does damage control resuscitation combine?

Answer 5

permissive hypotension and haemostatic resuscitation with damage control surgery

Question 6

When should permissive hypotension be used?

Answer 6

Until surgical haemostasis is achieved

this is the use of only enough fluid to achieve a radial pulse

Question 7

What should the duration of hypotensive resuscitation not exceed?

Answer 7

60 minutes

Question 8

Which drug increases the survival rate from traumatic haemorrhage?

Answer 8

tranexamic acid

Question 9

What is the dose of tranexamic acid?

Answer 9

1g IV over 10 minutes

followed by infusion of 1g over 8h

starting if after 4h may increase mortality

Question 10

What should not delay resus

Answer 10

spinal immobilisation

Question 11

What factors are associated with survival of traumatic cardiac arrest?

Answer 11

• presence of reactive pupils
• organised ECG rhythm
• respiratory activity

Question 12

When are chest compressions not the priority?

Answer 12

In cardiac arrest caused by hypovolaemia, cardiac tamponade or tension pneumothorax

Question 13

When can resuscitation attempts be stopped in traumatic cardiac arrest?

Answer 13

If there is no response within 20 min of ALS, all reversible causes have been excluded and there is no detectable cardiac activity on US

Question 14

How should you treat compressible external haemorrhage?

Answer 14

Elevation and direct pressure

use tourniquets if needed/apply haemostatic agents

Question 15

How should you treat non-compressible haemorrhage?

Answer 15

Use splints (e.g pelvic), blood products and tranexamic acid while moving the patient to surgical/radiological control

Question 16

what can be used in patients with exsanguinating and uncontrollable infra-diaphragmatic torso haemorrhage?

Answer 16

Aortic occlusion

this can be achieved by resuscitative thoracotomy and cross-clamping of the descending aorta or use of an intravascular occlusion device

Question 17

What are the indicators of spinal injury?

Answer 17

• warm, vasodilated peripheries
• loss of reflexes below the injured segment
• severe hypotension with a low heart rate

Question 18

How can positive pressure ventilation cause adverse outcomes?

Answer 18

causes circulatory depression and potentially cardiac arrest by impeding venous return to the heart

Question 19

How can you prevent adverse outcomes from ventilation?

Answer 19

Setting the lowest minute volume consistent with normocapnia will mimimise rise in transpulmonary pressure and reduce negative impact on cardiac output

Question 20

During CPR use ____ % O2

Answer 20

100

Question 21

In peri-arrest or ROSC patients titrate o2 to …

Answer 21

SpO2 94-98%

Question 22

When does cardiac tamponade most commonly occur?

Answer 22

After penetrating injury or cardiac surgery

Question 23

What is needed in traumatic cardiac arrest with penetrating injury to the chest or epigastrium?

Answer 23

immediate resuscitative thoracotomy with a clamshell incision, and opening of the pericardium to relieve tamponade

Question 24

Why does needle aspiration of the pericardium prove ineffective?

Answer 24

Blood will be clotted

Question 25

When is a resuscitative thoracotomy indicated?

Answer 25

in patients with penetrating chest trauma in whom less than 15 minutes have elapsed since loss of vital signs