PCTH - Trauma Cardiac Arrest Medical Directive Flashcards
(48 cards)
Trauma Cardiac Arrest Medical Directive
Indications
Cardiac arrest secondary to severe blunt or penetrating trauma
Trauma Cardiac Arrest Medical Directive
Conditions for: CPR, Manual Defib, AED Defib, and Trauma TOR
CPR: Altered LOA, other: performed in 2 minute intervals
Manual Defibrillation: Age ≥24 hours, altered LOA, other: VF or pulseless VT
AED Defibrillation: Age ≥24 hours, altered LOA, other: defibrillation indicated
Trauma TOR:
- Age ≥16 years
- altered LOA
- 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 closest ED ≥30 min transport time away
- OR PEA with closest ED ≥30 min transport time away
What is considered signs of life (as per trauma arrest TOR requirements)?
- any spontaneous movements
- adequate respiratory efforts
- organized electrical activity on ECG
- reactive pupils
If a trauma cardiac arrest pt is in PEA, what do you need to consider for a TOR?
Consider transport time:
* if <30 min away, transport
* >= 30 min, consider TOR
If a trauma arrest pt is asystolic, what do you have to consider for TOR?
If Signs of Life (SOL) are present:
- If no SOL since extricated, then consider TOR
- If SOL present, then consider transport time:
* if transport <30 min, transport
* if transport >= 30 min, consider TOR
Trauma Cardiac Arrest Medical Directive
Contraindications for: CPR, Manual Defibrillation, AED Defibrillation, Trauma TOR
CPR:
- Obviously dead as per BLS PCS
- Meet conditions of DNR Standard
Manual Defibrillation: Rhythms other than VF or pulseless VT
AED Defibrillation: Non-shockable rhythm
Trauma TOR:
- <16 y.o.
- defibrillation delivered
- SOL at any time since fully extricated medical contact
- PEA and closest ED <30 min transport time away
- Pt with penetrating trauma to torso or head/neck and LTH <30 min away
Trauma Cardiac Arrest Medical Directive
Treatment
1) Consider CPR as per current HSF
2) Consider manual defibrillation (if available and authorized)
-
Age: ≥24 hrs to <8 years
- Dose: 1 defibrillation
- Initial dose: 2J/kg
- Max # of doses: 1
-
Age: ≥8 years
- Dose: 1 defibrillation
- Initial dose: As per BH/manufacturer
- Max # of doses: 1
3) Consider AED/SAED defibrillation (if not using manual defibrillation)
-
Age: ≥24 hours to <8 years -WITH OR WITHOUT PEDIATRIC ATTENUTATOR CABLE
- Dose: 1 defibrillation
- Initial dose: as per RBHP/manufacturer
- Max # of doses: 1
-
Age: ≥8 years
- Dose: 1 defibrillation
- Initial dose: As per BH/manufacturer
- Max # of doses: 1
Mandatory Provincial Patch Point
Patch to BHP for authorization to apply the Trauma TOR if applicable. If BHP patch fails or Trauma TOR does not apply, transport to closest appropriate receiving facility following 1st analysis/defibrillation.
Trauma Cardiac Arrest Medical Directive
Clinical Considerations
- If no obvious external signs of significant blunt trauma, consider medical cardiac and treat according to the appropriate medical cardiac arrest directive
- SOL: any spontaneous movement, respiratory efforts, organized electrical activity on ECG, and reative pupils
- An IV bolus may be considered where it does not delay transport and should not be prioritized over management of other reversibly pathology
Can you shock a patient with a metal embedded object?
Yes
Describe the CPR guidelines for a neonate (>= 24h to <30 days), including CPR ratio, indications for CPR, defibrillation, and trauma/medical TOR.
Age: <30 days is considered neonate (Day 1 = day after their expected due date) but >= 24 hours to defib
Ratio: 3:1
CPR Indications: Pulse <60 and poor perfusion (usually unconscious)
defib: defib applicable
No trauma or medical TOR
Describe how the CPR ratio changes for a neonate when non-intubated vs. intubated.
Ratio does not change! Both non-intubated and intubated follows a 3:1 ratio
Describe the CPR guidelines for a child, including what age range constitutes a child, CPR ratio, indications for CPR, defibrillation, and trauma/medical TOR.
Age Range: ≥30days to puberty
CPR Ratio: 15:2
Indications for CPR: pulse <60 and poor perfusion (i.e. unconscious)
Defibrillation: SAED applicable
Trauma TOR/Medical TOR: N/A
Describe how the CPR ratio changes for a child intubated vs non-intubated.
Non-intubated: ratio of 15:2
Intubated: non-interrupted chest compressions
S/S of puberty when determining if a patient has reached puberty
hair in facial region, armpit, pubic/genital, breast development
Describe the CPR guidelines for a patient who has reached puberty but <16 years old, including CPR ratio, indications for CPR, defibrillation, and trauma/medical TOR.
Ratio: 30:2 unless secured (then continuous compressions with breaths 1 every 6-8 seconds)
CPR indications: No pulse
Defibrillation: SAED applicable
Trauma TOR/Medical TOR: N/A
Describe the CPR guidelines for a patient ≥16 y.o., including CPR ratio, indications for CPR, defibrillation, and trauma/medical TOR.
CPR Ratio: 30:2 unless secured (then continuous compressions with breaths 1 every 6-8 seconds)
CPR indications: No pulse
Defibrillation: SAED applicable
Trauma TOR: YES
Medical TOR: YES
Describe the defibrillation pad placement and general considerations when applying pads to ensure contact.
- R midclavicular line x L midaxillary line
- away from bony processes
- hair on chest (shave if necessary)
- dry pt if wet
What is the #1 cause of impedence in defibrillation?
poor pad contact
If patient has a pacemaker in the R midclavicular region (where you would typically put defib pad), how would you problem solve this?
just switch pads to the opposite side, it’ll do the same thing
i.e. one pad on top L chest under clavicle, one pad on R flank
If defibs pads are too close to each other, what alternative placements can you use?
Anterior-posterior (AP) - like a sandwich
You want pads to be ~hand width apart or more
What does a biphasic AED machine do and what is the purpose of it?
Biphasic machine shocks the patient twice basically (the charge goes through from one pad through the heart and then to the other and back the same way, eventually going through the heart twice)
The goal is to hit as many +vely charged cells in the heart as possible and this increases the likelihood of converting the rhythm
What are the preset adult defibrillation joule settings in the Medtronic Lifepack series?
200, 300, 360 joules
What are the preset adult defibrillation joule settings in the Philips MRX/FR2 series?
150 joules non-escalating
