Traumatic Cardiac Arrest SOP Flashcards
Outline the contents of the traumatic cardiac arrest SOP
Aim of treatment is to maximise the chance of a positive outcome by identifying and treating the common causes of TCA
Covers:
Principles of TCA management - HOTT
Special causes but doesn’t go into detail
TBI
Chest compressions
Triage to hospital
What are the principles of TCA management?
- Identify the underlying pathology based on mechanism, history and clinical examination
- The key reversible pathologies are hypovolaemia, hypoxia, tension pneumothorax and cardiac tamponade
- Nuanced, don’t give all interventions to all patients
Outline the management of hypovolaemia in the context of TCA
Stop the bleeding
- Spints, tourniquets, packing wounds
- Thoracotomy allows aortic compression
- TXA
Replace volume
- Large bore IVA
- Warm blood
- Calcium
Outline the management of hypoxia in the context of TCA
- Remember could be head, could be airway/chest
- iGel or ETT with FiO2 1.0
- Remember high airway pressures can impede venous return
Outline the management of tension pneumothorax in the context of TCA
- Evolve slowly if self-ventilating
- Could be exacerbated by IPPV
- Decompress with needle/finger +/- drain
- If ROSC and starts to breathe, don’t forget chest seal
- Probably better to tube and paralyse them and get them IPPV
Outline the management of cardiac tamponade in the context of TCA
- Blood accumulates in the pericardial sack and is often due to penetrating injury
- Suspicious on examination
- Can only be corrected by thoracotomy
Discuss the particular nuance of TBI in TCA
- Multiple mechanisms IBA or SAH causing VF
- Thorough examination, optimal oxygenation and target ventilation
Discuss the practicalities of chest compressions in the context of TCA
- Decision on if and how is made by clinical team
- Maximise cerebral, coronary and end organ perfusion
- Can delay them in order to perform critical interventions
- Maybe delay if empty heart or tamponade
