Page 138 - ATP-P 11th Ed

PHASE 2: IMMEDIATELY PRIOR TO EXTRICATION
9. Immediately prior to extrication, apply tourniquets to crushed extremities, if possible.
SECTION 1 10. Phase 2 Recommended Additional Resuscitative Drugs
Sodium bicarbonate—give 1mEq/kg IV immediately prior to extrication (Bristo-
jet 1–2 amps). Additional dosing of sodium bicarbonate may be required if dysrhyth-
mias or cardiac arrest persist after giving calcium chloride or gluconate.
PHASE 3: IMMEDIATELY FOLLOWING EXTRICATION

Cardiac Dysrhythmias or Arrest
11. CPR should be initiated if cardiac arrest develops following extrication. DO
NOT follow the TCCC guidelines on cardiac arrest.
12. If dysrhythmias are present, consider administering the following (adult doses):
calcium gluconate 10% 10mL or calcium chloride 10% 5mL IV over 2 minutes.
Calcium should not be given in bicarbonate containing solutions due to precipita-
tion of calcium carbonate.
Calcium Chloride should be given SLOW IV push to prevent vein necrosis.
13. Additional dosing of sodium bicarbonate may be required if dysrhythmias or
cardiac arrest persist after giving calcium gluconate or calcium chloride.
14. Administer 12mL of albuterol sulfate inhalation solution, 0.083% (2.5mg/3mL)
in nebulizer. Onset of effect: 30 minutes. Duration of action: 2 hours.
15. Alternatively, administer albuterol (Ventolin ), 2–3 puffs q5min, repeat up to 3 times.
®
The metered dose inhaler works best when used with a commercially produces spacer
or improvised spacer (e.g., cardboard from toilet paper roll, etc.).
16. Following extrication, once the patient is stabilized, be prepared to treat hyperkalemia
as tourniquets are released.

Disposition
Urgent Surgical evacuation

128 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 129