Traumatic cardiac arrest: Difference between revisions
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==Background== | ==Background== | ||
*Classically thought to invariably lead to death | |||
*However, recent data suggests that survival from traumatic cardiac arrest is similar to that of medical causes of [[cardiac arrest]]<ref>Traumatic cardiac arrest: who are the survivors? Lockey D, Crewdson K, Davies G. Ann Emerg Med. 2006 Sep; 48(3):240-4.</ref> | |||
**One military study demonstrated 24% survival of patients who underwent resuscitation after traumatic arrest<ref>The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27; 366(1562):171-91.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Initial rhythm usually [[PEA]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Differential diagnosis should be thought of in terms of reversible causes | |||
**Massive hemorrhage and hypovolemia | |||
**[[Tension pneumothorax]] | |||
**[[Hemothorax]] | |||
**[[Cardiac tamponade]] | |||
**[[Hypoxia]] and airway compromise | |||
**[[Pelvic trauma]] | |||
**Hemodynamically compromising long bone fractures | |||
==Evaluation== | ==Evaluation== | ||
*Pre-operation labs | |||
*Base excess, ABG/VBG, lactate | |||
*Type and cross | |||
*CXR | |||
*Pelvic XR | |||
*eFAST | |||
==Management== | ==Management== | ||
''General approach per [[Trauma (main)|ATLS]] guidelines'' | |||
*Large bore PIV or central line access with blood products, [[massive transfusion]] | |||
*Establishing resuscitation airway | |||
*Bilateral [[thoracostomy]], can do finger thoracostomies instead of tube or needle.<ref>Scott Weingart. Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?. EMCrit Blog. Published on December 11, 2011. Accessed on December 14th 2019. Available at [ https://emcrit.org/emcrit/needle-finger-thoracostomy/ ].</ref> | |||
*Emergency [[thoracotomy]] | |||
**If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade. | |||
*Consider [[REBOA]] catherization and balloon inflation | |||
*Long bone fracture reduction, if there is suspicion of significant enough hemorrhage | |||
*Pelvic binding | |||
*Surgical stabilization | |||
*Standard [[ACLS]] and BLS may delay critical interventions | |||
**No definitive animal or human evidence to support external chest compressions in traumatic cardiac arrest<ref>Smith JE et al. Traumatic cardiac arrest. J R Soc Med. 2015 Jan; 108(1): 11–16.</ref> | |||
**No evidence to support IV epinephrine in traumatic arrest, with the exception of [[neurogenic shock]] | |||
==Disposition== | ==Disposition== | ||
*Emergency surgery | |||
==See Also== | ==See Also== | ||
*[[Trauma (main)]] | |||
==External Links== | ==External Links== | ||
*Scott Weingart. EMCrit Podcast 135 – Trauma Thoughts with John Hinds. EMCrit Blog. Published on October 19, 2014. Accessed on December 14th 2019. Available at https://emcrit.org/emcrit/trauma-thoughts-john-hinds/ | |||
==References== | ==References== | ||
Latest revision as of 14:38, 11 January 2020
Background
- Classically thought to invariably lead to death
- However, recent data suggests that survival from traumatic cardiac arrest is similar to that of medical causes of cardiac arrest[1]
- One military study demonstrated 24% survival of patients who underwent resuscitation after traumatic arrest[2]
Clinical Features
- Initial rhythm usually PEA
Differential Diagnosis
- Differential diagnosis should be thought of in terms of reversible causes
- Massive hemorrhage and hypovolemia
- Tension pneumothorax
- Hemothorax
- Cardiac tamponade
- Hypoxia and airway compromise
- Pelvic trauma
- Hemodynamically compromising long bone fractures
Evaluation
- Pre-operation labs
- Base excess, ABG/VBG, lactate
- Type and cross
- CXR
- Pelvic XR
- eFAST
Management
General approach per ATLS guidelines
- Large bore PIV or central line access with blood products, massive transfusion
- Establishing resuscitation airway
- Bilateral thoracostomy, can do finger thoracostomies instead of tube or needle.[3]
- Emergency thoracotomy
- If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade.
- Consider REBOA catherization and balloon inflation
- Long bone fracture reduction, if there is suspicion of significant enough hemorrhage
- Pelvic binding
- Surgical stabilization
- Standard ACLS and BLS may delay critical interventions
- No definitive animal or human evidence to support external chest compressions in traumatic cardiac arrest[4]
- No evidence to support IV epinephrine in traumatic arrest, with the exception of neurogenic shock
Disposition
- Emergency surgery
See Also
External Links
- Scott Weingart. EMCrit Podcast 135 – Trauma Thoughts with John Hinds. EMCrit Blog. Published on October 19, 2014. Accessed on December 14th 2019. Available at https://emcrit.org/emcrit/trauma-thoughts-john-hinds/
References
- ↑ Traumatic cardiac arrest: who are the survivors? Lockey D, Crewdson K, Davies G. Ann Emerg Med. 2006 Sep; 48(3):240-4.
- ↑ The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27; 366(1562):171-91.
- ↑ Scott Weingart. Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?. EMCrit Blog. Published on December 11, 2011. Accessed on December 14th 2019. Available at [ https://emcrit.org/emcrit/needle-finger-thoracostomy/ ].
- ↑ Smith JE et al. Traumatic cardiac arrest. J R Soc Med. 2015 Jan; 108(1): 11–16.