Traumatic Cardiac Arrest
Traumatic cardiac arrest is a rare presentation to ambulance crews, but one that we can make huge differences to if we are drilled and resuscitate viable patients aggressively.
Guidelines state how chest compressions are demphasised, particularly in hypovolemic arrests. We should focus on doing the meaningful interventions quickly for these patients, before considering whether to restart compressions.
We discussed the evidence behind this reccomendation, looking at animal models and infusion strategies.
Dont forget that there can be medical components or medical arrests that present with a history of minor trauma… dont miss these and if there is any doubt, conduct a conventional resuscitation whilst you gain history and fact find.
We need to stop or reduce bleeding by arresting external hamemorrhage, returning limbs to normal anatomical alignment and more than likely binding the patients pelvis
Filling patients is key, particularly when there is a PEA rhythm that may indicate a low flow state. Access to blood products in these early viable patinets is probably best, but absolutely fill them with fluid if thats all you have. Getting volume in the tank is what we need.
Address oxygenation requirements with good airway management and have a low threshold for bilateral chest decompression, remember we may not get the hard signs we typically look for in diagnosing a tension pnemouthorax and even a relatively small amount of air will cause cardiovascular collapse in an underfilled patient.
Gettting access to an critical care team in these patients is really important, as they may require a thoracotomy to address cardiac tampanade. This is particularly important in penetrating chest trauma.
Finally, weve discussed the aftermath, remember these are likely to be crimescenes after the resuscitation is over so try to preserve the scene integrity where possible and make sure to look after yourselves and your colleagues following the debrief these are rare and emotionally charged jobs.