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
-
- See COG 1.4 for criteria for death/withholding resuscitation
- Contact Coroner
-
- Immediate continuous compressions
-
- Place advanced airway and provide 8-10 breaths per minute
-
- Treat correctable causes early
V-fib/pulseless V-tach ?
-
- Defibrillate 200 joules, 300 joules, 360 joules;
-
- all subsequent shocks at 360 joules
-
- Place 2nd IV/IO when feasible
PEA > 30 ?
-
- Place 2nd IV/IO when feasible
Return of spontaneous circulation ?
-
- Notify receiving facility or contact Medical Control
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.