Trauma Resuscitation Flashcards
(42 cards)
Any patient that is in cardiac arrest as a result of electrocution or lightning should receive ____
immediate defibrillation, if applicable.
Do no resuscitate trauma patients if all of the following signs of death are present:
Injuries incapable with life and/ or
- Apneic
- Pulseless (Asystole confirmed in two leads)
- Fixed and dilated pupils
Note: Trauma patients in cardiac arrest (either found to be in arrest or have arrested in the presence of Fire Rescue personnel), ____ or ____ SHOULD BE PERFORMED. Resuscitation efforts do NOT need to be continued if ____.
- prophylactic bilateral needle decompression OR FINGER THORACOSTOMY
- the patient did not regain pulses immediately following the bilateral needle decompression OR
THORACOSTOMY
Hemorrhagic Shock
Adult
Management:
• Rapid transport, keep on-scene times less than 10 minutes.
• Maintain an SpO2of 95% and EtCO2 levels between 35-45mmHg.
• Control external severe extremity hemorrhage (direct pressure, Combat Application
Tourniquet (C.A.T.), apply CAT at the most proximal anatomical location of extremity until the bleeding stops). Never apply C.A.T. directly over injury site or joint.
• If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and groin) and any other severe external hemorrhage that is not able to be easily controlled using C.A.T). shall be controlled using clotting agent or
XSTAT. Pack wound with clotting agent and maintain pressure for a minimum of one minute. USE ISRALI BANDAGE WHEN APPROPRIATE.
• Cervical Spinal Motion Restriction if indicated.
• Maintain body temperature with blankets and consider increasing the
temperature in the patient compartment.
Hemorrhagic Shock
Fluid Resuscitation
• Internal hemorrhage
- Establish two large bore IVs while en route. NEVER delay transport to start IV’s on scene.
- Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 90 mmHg, which is the goal of fluid resuscitation for a patient with suspected internal hemorrhage.
- Bolus of Normal Saline 500mL, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.- Permissive Hypotension in trauma
Hemorrhagic Shock
Fluid Resuscitation
• Isolated external hemorrhage controlled with direct pressure or Combat Application Tourniquet (C.A.T.)
- Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 80-90 mmHg.
- Bolus of Normal Saline 500ml, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.
- BLOOD TRANSFUSION: See Protocol
Hemorrhagic Shock
Pediatric - Management:
- Rapid transport, keep on-scene times less than 10 minutes.
- Maintain an SpO2 at 95% and EtCO2 levels between 35-45 mmHg.
- Control external severe extremity hemorrhage (direct pressure, Combat Application Tourniquet (C.A.T.), apply at the most proximal anatomical location of extremity until the bleeding stops). Never apply C.A.T. directly over injury site or joint.
- If clotting agent is available, severe junctional hemorrhage (e.g., neck, axillary, thoracic, abdominal, pelvis and groin) and any other severe external hemorrhage that is not able to be easily controlled using
- C.A.T. shall be controlled using clotting agent. Pack wound with clotting agent and maintain pressure for a minimum of one minute.
- Spinal Motion Restriction if indicated.
- Maintain body temperature with blankets.
Hemorrhagic Shock
Pediatric -
* Fluid resuscitation for suspected intra-thoracic, intra-abdominal or retroperitoneal hemorrhage or isolated external hemorrhage
• Establish two large bore IV’s or an IO if unable to obtain IV access. Do not delay transport!
• NORMAL SALINE: 20mL/kg bolus, titrated to maintain a SBP as listed below. May repeat 1x prn for
hypotension.
- Assess lung sounds and blood pressure often.
• Minimum Pediatric Systolic Blood Pressure Values
- Neonates: 60mmHg
- Infants: 70mmHg
- Children 1-10 years old: 70 +(age in years x 2) mmHg
- Children greater than 10 years old: 90mmHg
Pediatric
* Signs & Symptoms of Compensated Shock
• Anxiety, agitation, restlessness, normotensive, capillary refill normal to delayed
• Tachycardia (a weak rapid pulse greater than 130 beats/min is usually a sign of
shock in children of all ages except neonates)
Pediatric
* Signs & Symptoms of Decompensated Shock
Decreased LOC, hypotension, peripheral cyanosis, delayed capillary refill, inequality of central/distal pulses, and tachycardia (later progressing to bradycardia)
Neurogenic Shock
Signs & Symptoms
- Skin – Warm/Dry
- Hypotension with bradycardia
- Paralysis : Injury present above the T6 spinal cord level
- (Neurogenic Shock vs. Spinal Shock)
Neurogenic Shock
Adult - Management
• Rapid transport, keep on-scene times less than 10minutes.
• Maintain an SpO2of 95% and EtCO2 levels between 35-45mmHg.
• Cervical Spinal Motion Restriction if indicated.
• Maintain body temperature with blankets and consider increasing the temperature in
the patient compartment.
Neurogenic Shock
Adult - Fluid Resuscitation
• Establish two large bore IVs while en route. NEVER delay transport to start IV’s on scene.
• Internal hemorrhage
• Give enough normal saline up to 1L to maintain a blood pressure high enough for
adequate peripheral perfusion (radial pulse). The presence of a radial pulse equates to a SBP of 90 mmHg, which is the goal of fluid resuscitation for a patient with suspected
internal hemorrhage.
• Bolus of Normal Saline 500mL, reassess blood pressure and lung sounds prior to each bolus. Maximum 1L.-
• Push Dose Epinephrine: If patient remains hypotensive despite IVF
Neurogenic Shock
If Patient remains hypotensive after fluid administration.
Push dose Epinephrine
Neurogenic Shock
If Patient is hypotensive
(SBP less than 100mmHg)
NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
Transfusion Protocol
Universal Patient Guidelines
- Assure Scene safety. Primary Survey / Control Severe Traumatic Bleeding
18 or 20-gauge catheter x (2) or IO Humeral (preferably)
Transfusion Protocol
History
• What was the mechanism of injury – blunt (MVC, fall, blow to body) vs. penetrating
(stabbing, GSW, foreign body)?
• Did a medical condition contribute to the mechanism of injury? Other medical
conditions?
• Medications – Coumadin? Plavix? Aspirin? Pradaxa? Xarelto? Eliquis? (any blood thinners or anticoagulants)
• Beta Blockers and Calcium Channel Blockers may not allow HR to increase
appropriately
Transfusion Protocol
MARCHES Protocol
• Massive bleeding control
• Airway – NPA/OPA/Advanced Airway
• Respiratory – decompress chest if tension pneumothorax, occlusive dressing for open
pneumothorax
• Circulation- IV/IO, tourniquet, pelvic binder, wound packing
• Hypothermia care
• Eye injuries – cover with rigid shield and no pressure on the eye
• Spinal motion restriction if indicated
Transfusion Protocol
Criteria
HEMORRHAGIC SHOCK in medical or trauma Adult and Pediatric patients
* Relative Contraindications
• Patient < 6 years old
Consult Medical Direction if patient is in hemorrhagic shock and < 6 y/o
Medical Director may elect to give blood in patients < 6 y/o
Transfusion Protocol
Contraindications
• Religious objection to receiving blood products—consult On Call Medical Director
Transfusion Protocol
For Patients in HEMORRHAGIC SHOCK: Blunt or Penetrating Trauma-1 of the following
Administer Whole Blood with signs of acute hemorrhagic shock as evidenced by:
• Systolic Blood Pressure <70 mmHg
OR
• Systolic Blood Pressure <90 mmHg with- Heart Rate ≥ 110 beats per min
OR
• ETCO2 < 25
OR
• Witnessed traumatic arrest < 5 min prior to provider arrival and continuous CPR
throughout downtime
OR
• Age ≥ 65 y/o and SBP ≤ 100 AND HR ≥ 100 beats per minute
Transfusion Protocol
Information
In general one unit 500mL (1 unit) of Low Titer O+ Whole Blood (LTO+WB) will be
available per patient. If more than 500 mL of Whole Blood is available on scene the
following general guidelines apply:
• 6-10 y/o are eligible for 500 mL of Whole Blood
• 11-13 y/o are eligible for 1000 mL of Whole Blood
• ≥13 y/o are eligible for >1000 mL of Whole Blood
Of Note: At this time the LTO+WB does not have volume markings on the bag.
Transfusion Protocol
Confirmation Procedure
- Confirm patent administration site if any question exists utilize a new site
- Identify the patient meets criteria above
- Record baseline vitals
- (2) EMS personnel must confirm the tag and the blood product match including
number, blood type, Rh factor, expiration date and fluid amount - Both confirming personnel must sign the accompanying blood component tag
Transfusion Protocol
Administration
- Place flat thermometer on patient’s forehead.
- Whole Blood 1 unit IV/IO via blood Y-tubing. Flow through blood warmer to
completion and / or hemodynamic stability. Repeat PRN x 1. Utilize low titer O+ for most
patients, utilize low titer O – for female patients < 40. - In the event Whole Blood is not available Low Titer A Liquid Plasma may be
given to reach permissive hypotension with hemodynamic stability. Repeat PRN x 1.
