Traumatic/Peri-Arrest Cardiac Arrest

Question 1

What Qualifies?

Answer 1

• Peri-Arrest (those who are about to lose pulses)
• EMS-witnessed Cardiac Arrest due to Trauma
• Trauma patients NOT meeting Dead on Scene AG termination criteria

Question 2

2 Actual Scenarios

Answer 2

• Medical Cardiac Arrest suspected by Low MOI = OHCA AG
• Actual Traumatic Cardiac Arrest = Trauma Code

Question 3

Trauma Code Priorities

Answer 3

Withhold Compressions & Simultaneously perform Life Saving Interventions (ABC’s)

Question 4

Course of Actions (ABC’s)

Answer 4

• Direct pressure/tourniquet for external hemorrhage
• Pelvic binder for suspected pelvic fracture
• Provide high flow oxygenation and if needed provide assisted ventilation (igel or BVM preferred)
• 2 large bore IV/proximal IO access
• Volume replacement (max 40 cc/kg or 2L for adults)
• Consider bilateral chest decompression
• C-Collar

Question 5

Possible Outcomes

Answer 5

Consider withdrawal of efforts per Dead on Scene AG if no signs of life after Life Saving Interventions

OR

Initiate Transport!!

Question 6

If Transporting..

Answer 6

• Level 1 Trauma Center
• Administer TXA & Fluids en route
• Pulseless = Start/Resume Compressions

Question 7

TX

Answer 7

> 14 years: TXA 2g IV/IO SIVP (over at least 2 min) if
shock index >1

<14 years: TXA 30 mg/kg SIVP (over at least 2 min)
for patients with shock (SBP < 70 + 2 x age)

NS/LR fluid bolus to keep
SBP >70 mmHg
Max fluid 40 cc/kg (2L for adult)