THE TRAUMA CARDIORESPIRATORY ARREST

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THE TRAUMA CARDIOPULMONARY ARREST
Courtesy of Bonnie Meneely, R.N.
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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 lt90 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?