Adult:

Traumatic Cardiac Arrest

 

History:

 

  • Past medical history
  • Medications
  • End stage renal disease
  • Estimated downtime
  • Suspected hypothermia
  • Suspected overdose
  • DNR form

 

Significant Findings:

 

  • Unresponsive
  • Pulseless
  • Apneic
  • No electrical activity on EKG
  • V-fib/V-tach
  • No auscultated heart tones

 

Withhold resuscitation: ?

 

    • No pulse and asystole or
    • PEA <30 bpm or
    • Injuries incompatible with life

 

Consider terminating resuscitation if at any time patient presents with asystole or wide complex PEA   < 30

 

Criteria for Death/DNR

 

  • Yes

 

    • See COG 1.4 for criteria for death/withholding resuscitation
    • Contact Coroner

 

  • No

 

    • Rapid Transport
    • Immediate continuous compressions
    • Cardiac monitor/AED
    • Initiate IV/IO
    • Place advanced airway and provide 8-10 breaths per minute
    • Treat correctable causes early

 

V-fib/pulseless V-tach ?

 

  • Yes

 

    • Defibrillate 200 joules, 300 joules, 360 joules;
    • all subsequent shocks at 360 joules
    • Place 2nd IV/IO when feasible

 

PEA > 30 ?

 

  • Yes

 

 

    • Place 2nd IV/IO when feasible

 

Return of spontaneous circulation ?

 

  • Yes

 

    • Notify receiving facility or contact Medical Control

 

  • No

 

 

PEARLS:

 

  • Epinephrine given every 3-5 minutes, max 4 doses. Contact medical control to request more doses.
  • Hangings are not considered trauma. See appropriate medical protocol.
  • Always confirm asystole in more than one lead.
  • Assign a team resuscitation leader and utilize checklist.
  • Place monitor in paddles mode with metronome on.
  • Reassess and document endotracheal tube placement and EtCO2 frequently, after every move, and at transfer of care.