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Trauma

TRAUMATIC ARREST

Signs and Symptoms: Differential Diagnosis:
• Evidence of Trauma with No • Medical Cause of Arrest
Pulse Preceding Trauma*
• Lack of Response to • Tension Pneumothorax
External Stimuli • Hypovolemia
• Cardiac Tamponade
Continued from:
Tactical Evacuation Guideline
Do NOT attempt Injuries obviously incompatible
resuscitation YES with life? (*See Pearls)
NO
Initiate Blood Products Address all known points of
hemorrhage
In MASCAL situations / multiple victims:
Once passive airway maneuvers have been TXA 2g IV/IO over 1 min
attempted with no restoration of spontaneous START CPR
breathing, do not attempt further resuscitation
until other patients have been assessed and
triaged. (Triage using the SALT algorithm) Place Advanced Airway Start Supplemental O2
https://chemm.nlm.nih.gov/salttriage.htm
Bilateral NEEDLE THORACOSTOMY
Consider Bilateral Finger Thoracostomy Advanced Procedures to Consider VF/pulseless VT?
Consider Bilateral Tube Thoracostomy Place on Monitor: Ready Defibrillator Consider: CARDIAC
Consider Pericardiocentesis ARREST GUIDELINE
(After blood loss
Pulse Return?
YES Normal Respirations / Rhythm stopped and fluid
resuscitation
NO maximized)
• Continue CPR
• Continue Blood and IV Fluids
• Reduce Long Bone Fractures Consider:
Return to: • Reduce Pelvic Fracture Advanced Procedures
TACTICAL • Stop Known Blood Loss
EVACUATION Optimize Hemostasis!
or Previous Guideline
YES Pulse Return? NO
Pearls:
• Injuries obviously incompatible with life include decapitation, massively deforming head/chest injury, traumatic
hemi-corpectomy or total body disruption, incineration, lividity/rigor mortis.
• If unsure if arrest due to trauma or medical cause, initiate ALS guideline for any arrhythmias following optimization
of hemostasis (in trauma patients, volume loss must be corrected 1 st , consider blood admin 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.

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