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Part 10.7: Cardiac Arrest Associated With Trauma
asic and advanced life support for the trauma patient are fundamentally thesame as that for the patient with a primary cardiac arrest, with focus on support of airway, breathing, and circulation. In trauma resuscitation providers perform the Primary Survey (called the initial assessment in the National Highway Traffic Safety Administration [NHTSA] EMS Curricula), with rapid evaluation and stabilization of the airway, breathing, and circulation. This is followed by theSecondary Survey (called the focused history and detailed physical examination in the NHTSA courses), which detects more subtle but potentially lethal injuries. Cardiopulmonary deterioration associated with trauma has several possible causes:
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Hypoxia secondary to respiratory arrest, airway obstruction, large open pneumothorax, tracheobronchial injury, or thoracoabdominalinjury Injury to vital structures, such as the heart, aorta, or pulmonary arteries Severe head injury with secondary cardiovascular collapse Underlying medical problems or other conditions that led to the injury, such as sudden cardiac arrest (eg, ventricular fibrillation [VF]) in the driver of a motor vehicle or in the victim of an electric shock) Diminished cardiac output or pulseless arrest(pulseless electrical activity [PEA]) from tension pneumothorax or pericardial tamponade Extreme blood loss leading to hypovolemia and diminished delivery of oxygen
effective and whether they adversely delay transport to, and definitive management at, a hospital or emergency department (ED). There is considerable evidence that out-of-hospital endotracheal intubation is either harmful or at bestineffective for most EMS patients.10 –13 Researchers and emergency medical services (EMS) leaders have also questioned the safety and effectiveness of aggressive out-of-hospital IV fluid resuscitation in an urban environment.14 –17 In addition, field ACLS interventions unquestionably prolong time at the scene, delay transport to the ED or trauma center, and thereby delay essential interventions,such as surgical control of lifethreatening bleeding.17–20 With the above discussion in mind, the focus of prehospital resuscitation should be to safely extricate and attempt to stabilize the patient and to minimize interventions that will delay transport to definitive care. Strict attention should be paid to stabilizing the spine during care. Patients suspected of having severe traumatic injuriesshould be transported or receive early transfer to a facility that can provide definitive trauma care. Attempts to stabilize the patient are typically performed during transport to avoid delay.
BLS for Cardiac Arrest Associated With Trauma
When multisystem trauma is present or trauma involves the head and neck, rescuers must stabilize the spine during all BLS maneuvers. A jaw thrust...