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TRAUMATIC ARREST
History History (Differential)
• Evidence of trauma without a pulse • Medical cause of arrest preceding trauma
• Unresponsive to external stimuli • Tension pneumothorax
• Hypovolemia
• Cardiac tamponade
Treatment
• Determine if injuries are incompatible with life
˚ Do not resuscitate if injuries are incompatible with life
• Address all known points of hemorrhage
˚ Initiate transfusion with 1 unit of blood product (avoid resuscitation with crystalloid)
˚
TXA 2g IV/IO within 3hr of injury
• Begin CPR
˚ Do not perform CPR at the expense of life-saving care to other casualties
• Place an advanced airway
˚ Start supplemental O 2
• Bilateral needle thoracostomy
• Consider advanced procedures
˚ Finger thoracostomy
˚ Tube thoracostomy
˚
Pericardiocentesis
• Place the monitor on the patient; prepare the defibrillator
˚ Determine rhythm; pulse return?
• ROSC not achieved
˚ Continue CPR
˚ Continue blood/IV fluids
˚ Reduce long bone fractures
˚ Reduce pelvic fracture
Reassess known hemorrhage points
˚
• ROSC achieved
˚ Return to TACTICAL EVACUATION PROTOCOL or previous protocol
Notes, Cautions, Warnings
• Injuries obviously incompatible with life include decapitation, massively deforming head
or chest injury, traumatic hemicorpectomy, or total body disruption, incineration, lividity/
rigor mortis
• Casualties with torso trauma or polytrauma who have no pulse or respirations during Tactical
Field Care should have bilateral needle decompression performed to ensure they do not have a
tension pneumothorax prior to discontinuation of care.
• If unsure if arrest is due to trauma or medical cause, initiate ALS guideline for any arrhythmias
following optimization of hemostasis (in trauma patients, correct volume loss first, consider
blood administration above all else)
• CPR without addressing massive hemorrhage, blood volume resuscitation, tension
pneumothorax, and pericardial tamponade will be ineffective
• Consider severe hypocalcemia if blood products have recently been transfused due to calcium
chelation and evidence of poor cardiac activity/contractility.
Reference: TCCC Guidelines, CPG ID #82 (Prehospital Blood Transfusion), CPG ID #20 (Emergent
Resuscitative Thoracotomy)

24 • TRAUMA