1. International Trauma Life Support for Prehospital Care Providers Sixth Edition for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Chapter 21 The Trauma Cardiopulmonary Arrest Chapter 21 The Trauma Cardiopulmonary Arrest

2. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ The Trauma Cardiopulmonary Arrest

3. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Traumatic cardiac arrest Guidelines for withholding resuscitation Treatable causes Proper evaluation and management 2Trauma Arrest -

4. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Unsalvageable Patient 3 Traumatic cardiopulmonary arrest survival is rare. Traumatic cardiopulmonary arrest survival is rare. Trauma Arrest -

5. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Unsalvageable Patient Resuscitation attempt and transport expose EMS and public to risks. Do not attempt unless chance of patient survival. 4Trauma Arrest -

6. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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 5Trauma Arrest -

7. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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. 6Trauma Arrest -

8. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Resuscitation Initiated No breathing, no pulse, no organized cardiac activity Mechanism of injury does not correlate with clinical condition Suggestive of nontraumatic cause 7Trauma Arrest -

9. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Resuscitation Terminated No breathing, no pulse, no organized cardiac activity EMS-witnessed cardiopulmonary arrest and 15 minutes of unsuccessful resuscitation Transport time to ED >15 minutes Special consideration Drowning, lightning strike, hypothermia 8Trauma Arrest -

10. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 9 Causes and Treatment of Traumatic Cardiopulmonary Arrest Causes and Treatment of Traumatic Cardiopulmonary Arrest Trauma Arrest -

11. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Trauma Arrest Treat underlying cause. Use ITLS Primary Survey to identify Prolonged hypoxemia is most common. Airway problems Breathing problems Circulation problems 10Trauma Arrest -

12. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Causes of Trauma Arrest Airway obstruction Foreign body Tongue prolapsed Swelling 11Trauma Arrest - Courtesy of Bonnie Meneely, EMT-P

13. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Causes of Trauma Arrest 12 Tension pneumothorax Sucking chest wound Flail chest High spinal-cord injury Carbon monoxide inhalation Smoke inhalation Breathing problems Trauma Arrest - Aspiration Near-drowning CNS depression from drugs/alcohol Apnea secondary to electric shock or lightning strike

14. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Causes of Trauma Arrest Circulatory problems Hemorrhagic shock Tension pneumothorax Pericardial tamponade Myocardial contusion Acute myocardial infarction Cardiac arrest secondary to electric shock 13Trauma Arrest -

15. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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 14Trauma Arrest -

16. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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 15Trauma Arrest -

17. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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 16Trauma Arrest -

18. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 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 17Trauma Arrest -

19. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Discussion 18Trauma Arrest - Courtesy of Eduardo Romero Hicks, MD