Trauma Cardiac Arrest | SWORBHP Ask MAC

Category Archives: Trauma Cardiac Arrest

June 20, 2022 SWORBHP Category: Medical Cardiac Arrest, Trauma Cardiac Arrest | Date: June-20-2022

So we had a call to a burn victim that was grossly charred, but was breathing. He started to deteriorate in transport but we made it to the hospital. I was wondering if he were to arrest if that would be a traumatic VSA, I know it's not a blunt or penetrating trauma but it doesn't make much sense as a medical cardiac arrest either. Also could a patient meet the standards for an obvious death after patient contact?

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Answer:

This is a very complex case. We will answer your question in two parts.

A trauma is an injury from a physical force, which can include burns. The Advanced Trauma Life Support (ATLS) program states: “burns are a significant type of injury that can occur alone or be coupled with blunt or penetrating trauma.”

A burn in isolation may not seem to meet the indications of the Traumatic Cardiac Arrest Medical Directive and consideration for TOR – “cardiac arrest secondary to blunt or penetrating trauma.” SWORBHP Medical Council would endorse treating burn patients as traumatic injuries and thus be treated under the Trauma Medical Arrest Medical Directive, if applicable. This will result in an early patch consultation which may assist with further direction (continue on scene resuscitation, transport or terminate)

If the patient is initially alive on contact but becomes vital signs absent during care with clinical features consistent with the “obviously dead criteria” of the Deceased Patient Standard, the most pertinent action would be to continue management per the ALS-PCS. As per the Preface of the BLS, “when providing patient care as per the Standards, a paramedic shall ensure that the patient simultaneously receives care in accordance with the Advanced Life Support Patient Care Standards (ALS-PCS)”. In the situation you detail, a patch to the BHP for consideration of Trauma TOR would be recommended.

It is important to remember that all of these cases of traumatic death, and fires will be Coroner’s cases, and involve Fire Marshal investigations. During transport this could result in the ambulance being taken off the road for an extended period of time, and not being able to attend 911 calls. In many cases obtaining a TOR could be challenging as fires can attract hundreds of people to the scene and become very public events with media. It is important to relay the location of the patient and the team’s recommendations when speaking to the BHP so we are best able to support you.

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April 27, 2021 SWORBHP Category: Trauma Cardiac Arrest | Date: 27-Apr-2021

Question: with regards to the Trauma Cardiac Arrest Medical Directive, do you support the placement of a pelvic binder on the patient assuming severe blunt trauma? I understand that under the Blunt/Penetrating Injury Standard in the BLS it is stated: "if the patient has a pelvic fracture, attempt to stabilize the clinically unstable pelvis with a circumferential sheet wrap or a commercial device". Furthering this thought, the Intravenous and Fluid Therapy Medical Directive found within the ALS PCS now states: "An intravenous fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes." Thinking about this all together has me wondering that if a patient who is VSA secondary to severe trauma is eligible to receive an IV bolus to presumably treat hypovolemic shock, would the use of a pelvic binder be supported in the same way? If so, when would be the recommendation to apply a pelvic binder when treating under the Trauma Cardiac Arrest Medical Directive? Thank you.

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Trauma Cardiac Arrest

April 6, 2021 SWORBHP Category: Supraglottic Airway, Trauma Cardiac Arrest, Covid-19 | Date: 06-April-2021

Since COVID supraglottic airways are highly recommended to be placed in a VSA patient prior to CPR. Is this for medical VSAs or does this apply to traumatic as well?

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January 29, 2021 SWORBHP Category: Trauma Cardiac Arrest | Date: 29-Jan-2021

Hi, I have a question in relation to the FTT standard. If I had a patient who was VSA on arrival due to a multi-system trauma (no penetrating injuries, only blunt), but does not qualify for trauma TOR because the closest ED is 10 minutes away but LTH is 20 minutes away... am I transporting to the ED or the LTH? I understand for penetrating injuries we are going to LTH if it's < 30 minutes, regardless of vital signs... but for other situations like the one I am stating, what is the appropriate action?

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Trauma Cardiac Arrest

February 4, 2020 SWORBHP Category: Adult Intraosseous, Pediatric Intraosseous, Trauma Cardiac Arrest | Date: 04-Feb-2020

Is a suspected pelvic fracture a contraindication to IO in the tibia?

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June 20, 2016 SWORBHP Category: Trauma Cardiac Arrest | Date: 20-Jun-2016

Question: If an 18 year old male hockey player was tackled and hit his face off the ice, has otorrhagea and and is VSA. First analysis shows asystole. Should he be treated under the trauma cardiac arrest directive or medical?

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Trauma Cardiac Arrest

January 12, 2015 SWORBHP Category: Trauma Cardiac Arrest | Date: 12-Jan-2015

Question: My question falls under the category of Trauma Cardiac Arrests. Are we expected to check the pulse of a PEA patient, secondary to trauma, every two minutes? I believe we do as this follows heart and stroke and also verifies a PEA is in fact pulseless.

The BLS states to reassess pulse every 2 minutes under medical section 2-18, but trauma section 3-6, referring to trauma VSA, states to follow ALS patient care standards and protocols.

Our protocol does not state or outline the desired pulse assessment treatment during transport after the one analysis is performed. Thank you in advance.

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Trauma Cardiac Arrest

April 8, 2014 SWORBHP Category: Trauma Cardiac Arrest | Date: 8-Apr-2014

Question: For Traumatic Cardiac arrest protocol in regards to age, is it = or > 16 or => 18?

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Trauma Cardiac Arrest

February 5, 2014 SWORBHP Category: Trauma Cardiac Arrest | Date: 5-Feb-2014

Question: My question is regarding Traumatic TOR caused by penetrating injury. I have been informed that penetrating trauma TOR is only allowed if it involves the head or torso. Is this correct or is it anywhere on the body? Thanks.

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Trauma Cardiac Arrest

December 20, 2013 SWORBHP Category: Medical Cardiac Arrest, Trauma Cardiac Arrest | Date: 20-Dec-2013

Question: There is some debate in regards to chest compression's, monitor applied, analyze and then airway. What happens when the compression count is at thirty and the pads are still not applied? Does the paramedic at the chest check the oral cavity, get the airway, insert it, open the BVM bag, prepare the BVM and attempt 2 breaths or continue compression's until the other medic applies the pads and the analysis is complete?

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Answer: The 2010 American Heart Association Guidelines (Berg et al Part 5: Adult Basic Life Support Circulation 2010) state the following in terms of initial rescuer sequence:

A change in the 2010 AHA Guidelines for CPR and ECC is to recommend the initiation of compressions before ventilations. While no published human or animal evidence demonstrates that starting CPR with 30 compressions rather than 2 ventilations leads to improved outcomes, it is clear that blood flow depends on chest compressions. Therefore, delays in, and interruptions of, chest compressions should be minimized throughout the entire resuscitation. Moreover, chest compressions can be started almost immediately, while positioning the head, achieving a seal for mouth-to-mouth rescue breathing, and getting a bag-mask apparatus for rescue breathing all take time. Beginning CPR with 30 compressions rather than 2 ventilations leads to a shorter delay to first compression (Class IIb, LOE C).

Once chest compressions have been started, a trained rescuer should deliver rescue breaths by mouth-to-mouth or bag-mask to provide oxygenation and ventilation, as follows:

Deliver each rescue breath over 1 second (Class IIa, LOE C).
Give a sufficient tidal volume to produce visible chest rise (Class IIa, LOE C).
Use a compression to ventilation ratio of 30 chest compressions to 2 ventilations.

The SWORBHP Medical Council advises that given the above, ventilations are required via a BVM after 30 compressions to achieve the recommended 30:2 compression ratio. You are absolutely correct that the priorities are good compressions and defibrillation. Paramedics should however work as a team on scene to apply the defibrillator as early as possible and ideally the defibrillator will be ready to analyze by the time the 30 compressions are complete.
However, to answer your specific question, if the defibrillator is not ready to analyze once the 30 compressions have been completed, interrupting compressions to provide 2 ventilations as per the recommended 30:2 ratio is acceptable.

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