Traumatic Resuscitation

Question 1

What are the clinical features of traumatic cardiac arrest?

Answer 1

History or presenting injury suggests a suspected traumatic cause of cardiac arrest; characterised by:

1. No signs of life:
   - Unresponsive
   - Inadequate respirations
   - Carotid pulse cannot be confidentially palpated within 10 sec
   or
2. Signs of inadequate perfusion:
   - Unresponsive
   - Pallor or central cyanosis
   - Pulse less than: 60 BPM in an infant, 40 BPM in a paediatric (1-12 years) or adult

Question 2

In what clinical circumstances may resuscitation not be commenced?

Answer 2

If the patient presents with injuries that are obviously incompatible with life including, decapitation, cranial/cerebral destruction, incineration.

Question 3

Outline the protocol for traumatic cardiac arrest.

Answer 3

Suspected traumatic aetiology OHCA.

Injuries incompatible with life?
If yes, manage as per ROLE

If no, address reversible causes.

HYPOVOLAEMIA, consider:

i) Catastrophic external/internal haemorrhage control
ii) Volume replacement
- IV/IO access (large bore preferred)
- 20 mL /kg sodium chloride 0.9% ; further 5-10 mL/kg boluses if required

HYPOXIA, consider:

• Basic airway adjuncts & manoeuvers
• IPPV
• Supraglottic airway / ETT

TENSION PNEUMOTHORAX, consider:
- Bilateral chest decompression

TAMPONADE, consider:
- Early conveyance to definitive care for resuscitative thoracotomy in patients presenting with penetrating trauma

Manage as per ROSC CPG or ROLE CPG if no improvement after 20 minutes of resuscitation & addressing reversible causes

Question 4

What are the reversible causes of traumatic cardiac arrest?

Answer 4

1. Hypovolemia
2. Hypoxemia
3. Tension pneumothorax
4. Cardiac tamponade