In this episode I discuss prehospital management of traumatic cardiac arrest, broken into penetrating and blunt. In recent years the pendulum has swung away from a nihilistic approach towards one that maximizes outcomes in the highest number of patients. This requires taking a standardized, aggressive approach when treating viable patients with traumatic arrest. In penetrating traumatic arrest, addressing reversible causes based on the location of the injury is essential. This primarily means hemorrhage control and volume restoration (ideally with blood products). It may also mean chest decompression (ideally with finger thoracostomy) for treatment of pneumothorax or hemothorax.

In blunt arrest it is more difficult to determine an underlying cause of arrest so a rehearsed, pre-planned “bundle” of care directed at reversible causes should be delivered early. Chest compressions should not be expected to be effective until volume is restored or tension physiology is reversed. This approach is attributed by most people to Dr. John Hinds.

Primary interventions include:

  1. Aggressive control of external hemorrhage.
  2. Maintenance of airway and ensuring oxygenation, ideally with intubation
  3. Decompression of both sides of the chest, ideally with finger thoracostomy but needle thoracostomy at minimum
  4. Application of a pelvic binder
  5. Reduction of all long bone fractures

References

    Scott Weingart. EMCrit Podcast 135 – Trauma Thoughts with John Hinds. EMCrit Blog. Published on October 19, 2014. Accessed on May 24th 2019. Available at [https://emcrit.org/emcrit/trauma-thoughts-john-hinds/ ].
    Traumatic cardiac arrest: a unique approach. Harris T, Masud S, Lamond A, Abu-Habsa M. Eur J Emerg Med. 2015 Apr;22(2):72-8. doi: 10.1097/MEJ.0000000000000180. Review.
    Konesky KL, Guo WA. Eur J Trauma Emerg Surg. 2018 Dec;44(6):903-908. doi: 10.1007/s00068-017-0875-6. Epub 2017 Nov 25.
    Escutnaire J, Genin M, Babykina E, Dumont C, Javaudin F, Baert V, Mols P, Gräsner JT, Wiel E, Gueugniaud PY, Tazarourte K, Hubert H; on behalf GR-RéAC. Resuscitation. 2018 Oct;131:48-54. doi: 10.1016/j.resuscitation.2018.07.032. Epub 2018 Jul 27.
    Evans CC, Petersen A, Meier EN, et al. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81(2):285–293. doi:10.1097/TA.0000000000001070
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