seventh edition

International Trauma Life Support

for Emergency Care Providers Cardiopulmonary Arrest in the Trauma Patient CHAPTER 21

Cardiopulmonary Arrest

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

© Pearson

Overview

• Traumatic cardiac arrest – Treatable causes – Proper evaluation and management – Guidelines for withholding resuscitation International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Unsalvageable Patient

Traumatic cardiopulmonary arrest survival is rare but some causes are correctable with prompt recognition and intervention.

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Unsalvageable Patient

• Resuscitation attempt and transport expose EMS and public to risks – Do not attempt unless chance of patient survival

© Alexander Sayganov

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Unsalvageable Patient

• Prehospital Trauma Arrest Guidelines – Joint Position Statement  National Association of EMS Physicians  American College of Surgeons Committee on Trauma – Guideline categories:  Resuscitation withheld  Resuscitation initiated  Resuscitation terminated International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Resuscitation Withheld

• No breathing, no pulse, no organized cardiac activity – Blunt trauma arrest on EMS arrival – Penetrating trauma arrest  No pupillary reflexes or spontaneous movement – Injuries incompatible with life – Evidence of significant time since pulselessness  Dependent lividity, rigor mortis, etc.

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Guidelines for Withholding or Terminating Resuscitation

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Causes and Treatment of Traumatic Cardiopulmonary Arrest (TCPA)

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Trauma Arrest

• • Treat underlying cause – Use ITLS Primary Survey to identify Prolonged hypoxemia is most common – Airway problems – Breathing problems – Circulation problems International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Causes of Trauma Arrest

• Airway problems – Foreign body – Tongue prolapsed – Swelling – Tracheal damage – Hemorrhage into airway – Misplaced advanced airway

Courtesy of Bonnie Meneely, EMT-P

International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Causes of Trauma Arrest

• Breathing problems – Tension pneumothorax – – – – – Sucking chest wound Flail chest Diaphragmatic injury High spinal-cord injury Carbon monoxide inhalation – – – – Smoke inhalation Aspiration Near-drowning CNS depression from drugs/alcohol – Apnea secondary to electric shock or lightning strike International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Causes of Trauma Arrest

• Circulatory problems – Hemorrhagic shock – Tension pneumothorax – Pericardial tamponade – Myocardial contusion – Acute myocardial infarction – Cardiac arrest secondary to electric shock International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Trauma Cardiac Arrest

• • Most victims: – Young – No preexisting cardiac disease • Scene Size-up is essential – Carefully record observations Different from medical cardiac arrest – 2 –4 liters normal saline rapid infusion International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Trauma Cardiac Arrest

• Special groups – Isolated head injury  Extent of injury not determined in field – Massive blunt injury  Resuscitation withheld if found asystolic – Children  Aggressively attempt resuscitation  Follow PALS guidelines International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Pregnant Patients

• Pregnant trauma arrest – Treatment priorities are same – Defibrillation settings are same – Drug dosages are same – Fluid volume needed increases  4 liters normal saline rapid infusion during transport International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Considerations in Management

• Airway – Optimal airway unclear – ETI – Prolonged periods of hypoxia – Risk of aspiration – Survival the same ETI or SAD International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Considerations in Management

• Ventilation – Positive pressure ventilation reduces venous return – Avoid over-ventilation  8 per minute with 750 cc tidal volume (adult) • Capnography – Low CO 2 – Rising CO indicates O 2 2 in cells is low indicates improving circulation – Establish correct ventilatory rate International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians

Summary

• • Traumatic arrest survival is rare Prehospital Trauma Arrest Guidelines: – Do not resuscitate unsalvageable patients • Identify and treat underlying cause: – ITLS Primary Survey – Aggressive airway management – Aggressive breathing management – Aggressive circulatory management International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell • Alabama College of Emergency Physicians