4. TRAUMA EMERGENCIES
4.9 TRAUMATIC CARDIOPULMONARY ARREST
Cardiopulmonary arrest due to trauma may be reversible with prompt aggressive therapy. In the traumatic arrest patient, rapid transport to the nearest trauma center has shown to be the most critical element in patient survivability. This is more likely to be possible with penetrating as opposed to blunt trauma. Patients found in arrest, without any signs of life, by first- arriving EMS personnel have little probability of survival. Therefore, resuscitation of these patients should be considered only in situations where witnessed signs of life shortly before EMS arrival were noted or in exceptional circumstances (penetrating trauma, hypothermia, etc.). Successful management of these patients will require rapid assessment, stabilization and transportation to an appropriate Trauma Center as defined by regional point-of-entry guidelines. Activate air transport services as appropriate. NOTE: The use of a cardiac monitor or AED/SAED device should be considered (as appropriate for level of EMT) in those situations of traumatic arrest wherein time allows for this procedure without compromising patient care and time of transport. (Rare instances exist of cardiac arrest secondary to trauma to the chest wall (commotio cordis) and should be appropriately managed per VF or V-Tach protocol).
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Initiate cardiopulmonary resuscitation (CPR)
4. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
5. Maintain an open airway and ventilate the patient. Assume spinal injury and treat accordingly.
6. Administer 100% high flow oxygen by bag valve mask.
7. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
8. Treat all life threatening conditions as they become identified.
9. When multiple patients are involved, they need to be appropriately triaged.
10. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse.
11. Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Initiate Cardiopulmonary Resuscitation (CPR)
4. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
5. Maintain an open airway and ventilate the patient. Assume spinal injury and treat accordingly.
6. Administer 100% high flow oxygen by bag valve mask.
7. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
8. Treat all life threatening conditions as they become identified (i.e., life threatening hemorrhage)
9. Contact MEDICAL CONTROL for potential utilization of PASG/MAST.
10. Activate ALS intercept and/or air transport, if deemed necessary and if available.
11. Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility.
12. Notify receiving hospital
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Initiate Cardiopulmonary resuscitation (CPR)
4. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
5. Maintain an open airway and ventilate the patient. Assume spinal injury and treat accordingly.
6. Administer 100% high flow oxygen by bag valve mask.
7. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
8. Treat all life threatening conditions as they become identified (i.e., life threatening hemorrhage)
9. ALS STANDING ORDERS
a. Provide advanced airway management.
b. Initiate 1-2 IVs Normal Saline. Administer 250 cc -500 cc bolus, wide open or titrated to patient's condition.
10. Contact MEDICAL CONTROL. Medical control may order:
a. IV Normal Saline 250 cc -500 cc bolus or wide open titrated to patient's condition.
b. Potential utilization of PASG/MAST.
11. Activate Paramedic intercept and/or air transport, if deemed necessary and if available.
12. Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility.
13. Notify receiving hospital
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Initiate Cardiopulmonary resuscitation (CPR)
4. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
5. Maintain an open airway and ventilate the patient. Assume spinal injury and treat accordingly.
6. Administer 100% high flow oxygen by bag valve mask.
7. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
8. Treat all life threatening conditions as they become identified (i.e., life threatening hemorrhage)
9. ALS STANDING ORDERS
a. Provide advanced airway management.
b. Initiate IV Normal Saline (1 - 2 large bore IVs).
c. Administer 250 cc - 500 cc bolus, wide open or titrate IV infusion rate to patient's hemodynamic status.
d. Application/inflation of PASG/MAST (if indicated).
e. Provide appropriate management for identified injuries:
- Head Injuries (see protocol)
- Thoracic Injuries (see protocol)
- Abdominal Injuries (see protocol)
f. Manage dysrhythmias per appropriate protocol en route.
10. Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility.
11. Activate air transport, if deemed necessary and if available.
12. Contact MEDICAL CONTROL. Medical control may order:
- Specific procedures as indicated (i.e. chest decompression, needle cricothyroidotomy)
13. Initiate transport as soon as possible.
14. Notify receiving hospital
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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