Trauma Cardiac Arrest Medical Directive

Question 1

Trauma Cardiac Arrest MD

What are the indications of the Trauma Cardiac Arrest MD?

Answer 1

Cardiac arrest secondary to severe blunt or penetrating trauma.

Question 2

Trauma Cardiac Arrest MD

What are the conditions for CPR?

Answer 2

LOA: Altered
Other: Performed in 2 minute intervals.

Question 3

Trauma Cardiac Arrest MD

What are the conditions for manual defibrillation?

Answer 3

Age: ≥24 hours
LOA: Altered
Other: VF OR pulseless VT

Question 4

Trauma Cardiac Arrest MD

What are the conditions for AED or SAED defibrillation?

Answer 4

Age: ≥24 hours
LOA: Altered
Other: Defibrillation indicated.

Question 5

Trauma Cardiac Arrest MD

What are the conditions for a Trauma TOR?

Answer 5

Age: ≥16 years
LOA: Altered
HR: 0
RR: 0
Other: No palpable pulses
AND
No defibrillation delivered
AND
Rhythm asystole
AND
No signs of life at any time since fully extricated
OR
Signs of life when fully extricated with the closest ED ≥ 30 min transport time away
OR
Rhythm PEA with the closest ED ≥30 min transport time away.

Question 6

Trauma Cardiac Arrest MD

What are the contraindications to CPR?

Answer 6

Obviously dead as per BLS PCS.
Meet conditions of Do Not Resuscitate (DNR) Standard.

Question 7

Trauma Cardiac Arrest MD

What are the contraindications to manual defibrillation?

Answer 7

Rhythms other than VF or pulseless VT.

Question 8

Trauma Cardiac Arrest MD

What are the contraindications to AED or SAED defibrillation?

Answer 8

Non-shockable rhythm

Question 9

Trauma Cardiac Arrest MD

What are the contraindications to the Trauma TOR?

Answer 9

Age <16 years.
Defibrillation delivered.
Signs of life at any time since full extricated medical contact.
Rhythm PEA and closest ED <30 min transport time away.
Patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital <30 min transport time away.

Question 10

Trauma Cardiac Arrest MD

What is the dosing for manual defibrillation ≥24 hours to <8 years?

Answer 10

2 J/kg. No dosing interval because max # of doses is 1.

Question 11

Trauma Cardiac Arrest MD

What is the dosing for manual defibrillation ≥8 years?

Answer 11

Dose as per RBHP/manufacturer. No dosing interval because max # of doses is 1.

Question 12

Trauma Cardiac Arrest MD

When should transport occur if Trauma TOR doesn’t apply or patch fails?

Answer 12

Transport to the closest appropriate receiving facility following the 1st analysis/defibrillation.

Question 13

Trauma Cardiac Arrest MD

What are considered signs of life for the Trauma Cardiac Arrest MD?

Answer 13

Any spontaneous movement, respiratory efforts, organized electrical activity on ECG, and reactive pupils.