TCA Principles

Question 1

Why is there a Different Approach than a Medical Arrest?

Answer 1

• Mechanical cause is more likely
• Different pathologies
• Different reversible causes
• Consider reversible causes sooner

Question 2

Approaches to Reversible Causes

Answer 2

• Must be carried out early or they will not get ROSC
• Concurrent w/ compressions
• Compressions can still take precedence but can also stop to do an intervention if not enough people
• Don’t use 4Hs/4Ts
• Use HOTT

Question 3

HOTT

Answer 3

Hypovolaemia
Oxygenation
Tension (Pneumothorax)
Tamponade

Question 4

Hypovolaemia

Answer 4

• External and internal haemorrhage control measured as needed
• Fluid management
• TXA only in post ROSC
• If not enough hands/for convenience bystanders can internally rotate the feet and keep traction on legs or compress pelvis if need be

Question 5

Oxygenation

Answer 5

• Get good control of airway
• Suction where needed
• ET if potentially indicated

Question 6

Tension (Pneumothorax)

Answer 6

• Any polytrauma it is routine to decompress bilaterally
• This is a temporising measure
• Definitive measure would be a thoracentesis by CCP/HEMS

Question 7

Tamponade

Answer 7

• Blood in pericardium, restricting the heart
• Penetrating trauma indicated thoracotomy
• If no HEMS/long run time consider early extraction

Question 8

Considerations

Answer 8

• Reversible causes vs compressions
• Fluids vs blood products
• Stay vs go
• Call CCD