Traumatic Arrest 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Focus on rapid and early BLS airway and ventilation tools. Intubation may not be the best option for these patients. 

□ Pediatric pads should be used in children < 25 Kg. 

□ Traumatic airway can cause hypoxia leading to bradycardia		□ Traumatic Mechanism 
□ Apnea 
□ Pulseless 
□ PEA 		□ Medical Cardiac Arrest 
□ Exsanguination 
□ Tension Pneumothorax 
□ Pelvic fracture(s) 
□ Hypoventilation 
□ Hypovolemia 
□ Hemorrhage 
□ Toxins 
□ Tamponade

Clinical Management Options

EMT-B
• Assess for obvious signs of death on arrival and withhold resuscitation if present (see pearls)
• Place tourniquets prior to or concurrent with CPR for major hemorrhagic injuries as indicated.  
• Perform Pit Crew CPR for Trauma with basic airway management until Paramedic arrives, and then pause • CPR as necessary for correctable traumatic causes of death. 
Paramedic
• Bilateral Needle Decompression for any torso trauma
• Consider non-transport if no ROSC or signs of life
• Consider advanced airway management
• Vascular access with Isotonic Crystalloid bolus until ROSC or up to 1 liter 
• Pull all extremities out to anatomical length/position. 
• Tranexamic Acid (TXA) 
• Calcium Chloride 
• 4-lead ECG placement and EtCO2 
• Consider Simple Thoracostomy(s)
Consult Online Medical Control as Needed

Pearls

  • Emphasis is to be placed on correcting traumatic causes of death (hemorrhage control, application of pelvic binder/closing open pelvic fractures with a sheet, ventilation, decompression of the chest, reduction of grossly deformed extremities, volume resuscitation, etc.) prior to or concurrent with initiating CPR. 
  • Chest decompression should not be delayed for any other medical procedure or intervention to be accomplished, including CPR. 
  • CPR should be paused during Simple Thoracostomy to minimize risk of provider injury. 
  • There is no indication for using the Lucas device for chest compressions in a traumatic cardiac arrest. However, if it has already been placed, it can be continued during transportation.
  • Traumatic arrest patients with short downtime and proximity to an appropriate trauma facility can be considered for transport after reasonable lifesaving interventions are first performed. 
  • In multi-patient events, traumatic arrests should not receive intervention until there are sufficient responders present to meet the needs of the living patients.
    • Except for lightning strikes, then perform reverse triage by giving higher priority to cardiac/respiratory arrests. 
  • Obvious signs of traumatic death include:
    • Rigor mortis or dependent lividity
    • the patient is apneic, pulseless, and without other signs of life upon EMS arrival including, but not limited to spontaneous movement, EKG activity, or pupillary response
    • Injuries incompatible with life (such as massive crush injury, complete exsanguination, severe displacement of brain matter)
    • Decapitation: the complete severing of the head from the remainder of the patient’s body
    • Transection of the torso: the body is completely cut across below the shoulders and above the hips through all major organs and vessels. The spinal column may or may not be severed
    • Incineration: 90% of body surface area with full thickness burns as exhibited by ash rather than clothing and complete absence of body hair with charred skin
  • Once transport has initiated, continue care while transporting to the closest Emergency Department
    • Children should go to a Level 1 trauma center