trauma arrest 21-1

Courtesy of Bonnie Meneely, R.N.

Chapter
XXI
THE
TRAUMA
CARDIOPULMONARY
ARREST
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Overview
Causes of cardiac arrest in trauma
patients
Management of cardiac arrest in
trauma patients
Compare and contrast
management of traumatic arrest
with Advanced Cardiac Life
Support guidelines
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Traumatic Cardiac
Arrest
Very high mortality
Victims in asystole after massive blunt trauma
can be pronounced dead in the field.
Most trauma arrest victims
Young and healthy
Little underlying cardiac disease
Traumatic cardiac arrest is usually not
primary cardiac event.
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Treatment Plan
Management must be directed
towards identifying and treating
the cause of the arrest.
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Treatment Plan
Is the scene safe?
Airway management with cervical
spine control within <90 seconds
Examination and treatment en route
to the hospital
Early notification of the receiving
hospital
Activation of the trauma team
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BTLS Primary Survey
Use the Initial Assessment to
identify arrest.
Establish airway.
Place patient on backboard and
transport immediately.
Use Rapid Trauma Survey to
identify correctable causes of
arrest.
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Causes of Traumatic
Cardiac Arrest
Airway
Breathing
Circulation
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Airway Problems
Obstruction by
Foreign body
Tongue
Blood and vomitus
Fractures
Face, jaw, or larynx
Patients arrest from hypoxia.
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Breathing Problems
Sucking chest wound
Flail chest
High spinal cord injury
CNS depression
Head injury
Drugs/alcohol
Tension pneumothorax
All compromise ventilation.
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Breathing Problems
Smoke inhalation
Carbon monoxide
Aspiration
Near drowning
All impair exchange of oxygen.
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Circulatory Problems
Hemorrhagic shock
Tension pneumothorax
Pericardial tamponade
Myocardial contusion
Myocardial infarction
Arrhythmia from electric shock or
lightning strike
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Management
Use Rapid Trauma Survey to identify cause
of arrest.
Secure airway with cervical spine
stabilization.
Intubation or surgical airway.
100% oxygen.
Transport immediately.
Support ventilation.
Monitor cardiac rhythm.
Defibrillate V-Fib.
Follow ACLS guidelines when other causes ruled out.
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Management
Assess neck veins and chest.
Rule out tension pneumothorax.
Needle decompression if present.
Establish IV access.
Rapid infusion of 2 liters of NS or
RL if patient is hypovolemic.
Control any bleeding.
Rapid transport to a trauma center.
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Important Points
Trauma arrest patient qualifies for
rapid extrication.
During transport three rescuers
needed to treat:
#1 Ventilate.
#2 Perform CPR.
#3 Identify and treat the cause of
the arrest.
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Special Situations
Trauma arrest in the pregnant patient or
child is treated the same as other
patients.
Electric shock patients:
Do not become a victim!
Usually are in V-Fib.
Respond to conventional ACLS.
Remember to protect the cervical spine.

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Do not delay transport of
the trauma arrest patient.
All treatment after
establishing the airway should
be done during transport to the
hospital.
Do not rely on ACLS alone.
Identify correctable causes.
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Summary
Have a Plan of Action.
Remember the ABCs.
Transport early.
Identify treatable causes.
Hypoxia
Late hemorrhagic shock
Cardiac tamponade
Tension pneumothorax
Open chest wound
Notify receiving facility early.
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Questions?