Page 172 - ATP-P 11th Ed

Management
1. Obtain IV/IO access.
SECTION 1 2. Stabilize spine as required to prevent neurologic deterioration.
3. Oxygen with pulse oximetry monitoring.
4. If respiratory distress exists due to high cervical spinal cord injury, secure airway (NPA,
ETT, surgical airway).
a. Intubate using in-line stabilization.
b. Consider surgical cricothyroidotomy (with local lidocaine) for unstable cervical
injury.
5. If patient is hypotensive:
a. Give 1L of normal saline or Ringer’s lactate IV/IO bolus. Consider additional flu-
ids if still hypotensive to maintain palpable radial pulse or systolic blood pressure
>90mmHg.
b. Hextend 500mL boluses may be used if crystalloids are unavailable to maintain
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palpable radial pulse or systolic blood pressure >90mmHg.
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c. Maximum of 2L of IV fluid (or 1L of Hextend ).
d. In cases of suspected neurogenic/spinal shock (without evidence of uncontrolled
hemorrhage), if there is no blood pressure increase after 2L of crystalloid or 1L of
Hextend , give epinephrine as directed in #6.
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6. Push-dose epinephrine:
a. DO NOT GIVE UNDILUTED (1:1,000) EPINEPHRINE INTRAVENOUSLY.
b. Take a 10mL syringe and draw up 1mL of 1:1,000 epinephrine.
c. Then draw up 9mL of normal saline into this syringe.
d. Waste 9mL of this mixture, then draw up 9mL more of normal saline into the same
syringe.
e. Final concentration is 10mL of 1:100,000 epinephrine, 10mcg/mL.
f. Administer 0.5–2mL (5–20mcg) IV/IO to maintain radial pulse or systolic blood
pressure >90mmHg.
7. Skin breakdown begins within 30 minutes in the immobilized, hypotensive patient;
therefore frequent turning and padding of bony prominences is critical.
8. If available, atropine 0.5–1mg IV/IO push if patient is bradycardic. Repeat as necessary
every 3–5 minutes to maximum dose of 3mg.
a. Repeat as necessary every 3–5 minutes to maximum dose of 3mg.
b. Atropine doses <0.5mg may cause a paradoxical bradycardia.
9. Manage hypothermia.
Disposition
1. Urgent evacuation
2. Maintain spine stabilization throughout transport.

162 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 163