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Courtesy of Bonnie Meneely, R.N.

ChapterChapter

XXIXXI THE THE TRAUMA TRAUMA

CARDIOPULMONARY CARDIOPULMONARY ARRESTARREST

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OverviewOverview 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 Traumatic Cardiac ArrestArrest

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 PlanTreatment Plan

Management must be directed towards identifying and treating the cause of the arrest.

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Treatment Plan 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 SurveyBTLS 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 Causes of Traumatic Cardiac ArrestCardiac Arrest

Airway Breathing Circulation

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Airway ProblemsAirway Problems Obstruction by

» Foreign body» Tongue» Blood and vomitus» Fractures

Face, jaw, or larynx

Patients arrest from hypoxia.

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Breathing ProblemsBreathing 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 ProblemsBreathing Problems Smoke inhalation Carbon monoxide Aspiration Near drowning

All impair exchange of oxygen.

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Circulatory ProblemsCirculatory Problems Hemorrhagic shock Tension pneumothorax Pericardial tamponade Myocardial contusion Myocardial infarction Arrhythmia from electric shock or

lightning strike

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ManagementManagement 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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ManagementManagement 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 PointsImportant 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 SituationsSpecial 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 Do not delay transport of the trauma arrest patient.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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SummarySummary 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?Questions?