Traumatic cardiorespiratory arrest Flashcards
Which outcome is better in traumatic cardiorespiratory arrest?
Very high mortality but if ROSC is achieved there is favourable neurological outcomes
What are the causes of cardiac arrest in trauma patients?
- 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
what is the prevalent rhythm in traumatic cardiac arrest?
asystole and PEA
What is commotio cordis?
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
What does damage control resuscitation combine?
permissive hypotension and haemostatic resuscitation with damage control surgery
When should permissive hypotension be used?
Until surgical haemostasis is achieved
this is the use of only enough fluid to achieve a radial pulse
What should the duration of hypotensive resuscitation not exceed?
60 minutes
Which drug increases the survival rate from traumatic haemorrhage?
tranexamic acid
What is the dose of tranexamic acid?
1g IV over 10 minutes
followed by infusion of 1g over 8h
starting if after 4h may increase mortality
What should not delay resus
spinal immobilisation
What factors are associated with survival of traumatic cardiac arrest?
- presence of reactive pupils
- organised ECG rhythm
- respiratory activity
When are chest compressions not the priority?
In cardiac arrest caused by hypovolaemia, cardiac tamponade or tension pneumothorax
When can resuscitation attempts be stopped in traumatic cardiac arrest?
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
How should you treat compressible external haemorrhage?
Elevation and direct pressure
use tourniquets if needed/apply haemostatic agents
How should you treat non-compressible haemorrhage?
Use splints (e.g pelvic), blood products and tranexamic acid while moving the patient to surgical/radiological control
what can be used in patients with exsanguinating and uncontrollable infra-diaphragmatic torso haemorrhage?
Aortic occlusion
this can be achieved by resuscitative thoracotomy and cross-clamping of the descending aorta or use of an intravascular occlusion device
What are the indicators of spinal injury?
- warm, vasodilated peripheries
- loss of reflexes below the injured segment
- severe hypotension with a low heart rate
How can positive pressure ventilation cause adverse outcomes?
causes circulatory depression and potentially cardiac arrest by impeding venous return to the heart
How can you prevent adverse outcomes from ventilation?
Setting the lowest minute volume consistent with normocapnia will mimimise rise in transpulmonary pressure and reduce negative impact on cardiac output
During CPR use ____ % O2
100
In peri-arrest or ROSC patients titrate o2 to …
SpO2 94-98%
When does cardiac tamponade most commonly occur?
After penetrating injury or cardiac surgery
What is needed in traumatic cardiac arrest with penetrating injury to the chest or epigastrium?
immediate resuscitative thoracotomy with a clamshell incision, and opening of the pericardium to relieve tamponade
Why does needle aspiration of the pericardium prove ineffective?
Blood will be clotted
When is a resuscitative thoracotomy indicated?
in patients with penetrating chest trauma in whom less than 15 minutes have elapsed since loss of vital signs
