Traumatic cardiac arrest - Revision history

Rossdonaldson1: /* Management */

2020-01-11T14:38:47Z

Management

← Older revision		Revision as of 14:38, 11 January 2020
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	==Management==		==Management==
			''General approach per [[Trauma (main)\|ATLS]] guidelines''
	*Large bore PIV or central line access with blood products, [[massive transfusion]]		*Large bore PIV or central line access with blood products, [[massive transfusion]]
	*Establishing resuscitation airway		*Establishing resuscitation airway
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	*Emergency [[thoracotomy]]		*Emergency [[thoracotomy]]
	**If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade.		**If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade.
	*[[REBOA]] catherization and balloon inflation		*Consider [[REBOA]] catherization and balloon inflation
	*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage		*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage
	*Pelvic binding		*Pelvic binding

2020-01-11T14:32:40Z

Background

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	==Background==		==Background==
	*Classically thought to death ~~invariably~~		*Classically thought to invariably lead to death
	*However, recent data suggests that survival from traumatic cardiac arrest is similar to that of medical causes of [[cardiac arrest]]<ref>Traumatic cardiac arrest: who are the survivors? Lockey D, Crewdson K, Davies G. Ann Emerg Med. 2006 Sep; 48(3):240-4.</ref>		*However, recent data suggests that survival from traumatic cardiac arrest is similar to that of medical causes of [[cardiac arrest]]<ref>Traumatic cardiac arrest: who are the survivors? Lockey D, Crewdson K, Davies G. Ann Emerg Med. 2006 Sep; 48(3):240-4.</ref>
	**One military study demonstrated 24% survival of patients who underwent resuscitation after traumatic arrest<ref>The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27; 366(1562):171-91.</ref>		**One military study demonstrated 24% survival of patients who underwent resuscitation after traumatic arrest<ref>The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27; 366(1562):171-91.</ref>

2019-12-14T10:29:53Z

Management

← Older revision		Revision as of 10:29, 14 December 2019
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	*Large bore PIV or central line access with blood products, [[massive transfusion]]		*Large bore PIV or central line access with blood products, [[massive transfusion]]
	*Establishing resuscitation airway		*Establishing resuscitation airway
	*Bilateral [[thoracostomy]]		*Bilateral [[thoracostomy]], can do finger thoracostomies instead of tube or needle.<ref>Scott Weingart. Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?. EMCrit Blog. Published on December 11, 2011. Accessed on December 14th 2019. Available at [ https://emcrit.org/emcrit/needle-finger-thoracostomy/ ].</ref>
	*Emergency [[thoracotomy]]		*Emergency [[thoracotomy]]
			**If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade.
	*[[REBOA]] catherization and balloon inflation		*[[REBOA]] catherization and balloon inflation
	*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage		*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage

2019-12-14T10:15:39Z

External Links

← Older revision		Revision as of 10:15, 14 December 2019
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	==External Links==		==External Links==
			*Scott Weingart. EMCrit Podcast 135 – Trauma Thoughts with John Hinds. EMCrit Blog. Published on October 19, 2014. Accessed on December 14th 2019. Available at https://emcrit.org/emcrit/trauma-thoughts-john-hinds/

	==References==		==References==

2019-08-29T20:40:54Z

Differential Diagnosis

← Older revision		Revision as of 20:40, 29 August 2019
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	**[[Tension pneumothorax]]		**[[Tension pneumothorax]]
	**[[Hemothorax]]		**[[Hemothorax]]
	**[Cardiac tamponade]]		**[[Cardiac tamponade]]
	**[[Hypoxia]] and airway compromise		**[[Hypoxia]] and airway compromise
	**[[Pelvic trauma]]		**[[Pelvic trauma]]

2019-08-29T20:40:26Z

Management

← Older revision		Revision as of 20:40, 29 August 2019
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	*Emergency [[thoracotomy]]		*Emergency [[thoracotomy]]
	*[[REBOA]] catherization and balloon inflation		*[[REBOA]] catherization and balloon inflation
			*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage
			*Pelvic binding
	*Surgical stabilization		*Surgical stabilization
	*Standard [[ACLS]] and BLS may delay critical interventions		*Standard [[ACLS]] and BLS may delay critical interventions

2019-08-29T20:38:37Z

Disposition

2019-08-29T20:38:26Z

Management

← Older revision		Revision as of 20:38, 29 August 2019
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	==Management==		==Management==
			*Large bore PIV or central line access with blood products, [[massive transfusion]]
			*Establishing resuscitation airway
			*Bilateral [[thoracostomy]]
			*Emergency [[thoracotomy]]
			*[[REBOA]] catherization and balloon inflation
			*Surgical stabilization
			*Standard [[ACLS]] and BLS may delay critical interventions
			**No definitive animal or human evidence to support external chest compressions in traumatic cardiac arrest<ref>Smith JE et al. Traumatic cardiac arrest. J R Soc Med. 2015 Jan; 108(1): 11–16.</ref>
			**No evidence to support IV epinephrine in traumatic arrest, with the exception of [[neurogenic shock]]

	==Disposition==		==Disposition==

2019-08-29T20:32:07Z

Evaluation

2019-08-29T20:30:30Z

Differential Diagnosis

← Older revision		Revision as of 20:30, 29 August 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
			*Differential diagnosis should be thought of in terms of reversible causes
			**Massive hemorrhage and hypovolemia
			**[[Tension pneumothorax]]
			**[[Hemothorax]]
			**[Cardiac tamponade]]
			**[[Hypoxia]] and airway compromise
			**[[Pelvic trauma]]
			**Hemodynamically compromising long bone fractures

	==Evaluation==		==Evaluation==