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1910 TRAUMATIC

ARREST UPDATE

PITKIN COUNTY EMTAC

1910

YES!

SIGNS OF

LIFE?

To include Peri Arrest

*For patients with signs of life focus on Transport Transport Transport!*

  • Do not delay scene time, intervention to be done en route!
  • Identify mechanism and potential system involvement

8000

General Trauma

Care

Injuries incompatible

to life?

YES

Do not start CPR

0050 Field Pronouncement

0050

Changes:

*Removed statement about agency policy regarding medical control

*Copied statement from 1991 Termination of resuscitation protocol re: Coroner case following pronouncement

*Removed exclusion to field pronouncement, this was not relevant if patient has no signs of life

Non-survivable injury / No signs of life

*Decapitation

*Evidence of Massive head, chest, or abdominal trauma, or massive burn with charring

When in doubt, do your job!

Obvious signs of Death

*Dependent Lividity

*Rigor Mortis

*Decomposition

Critical trauma

Action (MARCH)

*Fast Exam: Rapid accomplishment of MARCH intervention based on available equipment and responding personnel

*Slow Exam: As additional resources and equipment arrive, reassess / improve interventions and assign roles

Fast Exam Example:

-Direct pressure

-BLS Airway

-Bilateral Decompression

-Pelvic Binder

-Blanket

Slow Exam Example:

-Tourniquet or two

-Advanced Airway

-Second round of decompression (consider site options?)

-Warm IV Fluids with the blankie

Needle

Thoracostomy

1120

Changes:

*Clarified explanation of Placement

* Removed reference to specialized Heimlich tubes

Placement

*Target 2nd intercostal space at mid-clavicular line

OR

*4th-5th intercostal space targeting anterior-axillary line.

Either approach is acceptable but generally the site with the least musculature overlying ribs is preferred.

*If patient improves and then deteriorates, insert another catheter at the same site

*If patient does not improve, consider an additional attempt at whichever site was not previously attempted

*2nd intercostal

space at

mid-clavicular

*4th-5th intercostal

space anterior-axillary

Perform

CPR

*Exhausted your scope and equipment?

*Literature shows; CPR will NOT cause harm, but also does nothing to improve the patient's condition.

*Focus on addressing reverisble causes-hypoxia and tension pneumo (~17% survivability). Cardiac arrest from hypovelemia is not reversible (irreversible phase of shock).

Max 10

Minutes CPR

No

ROSC?

*Added: Contact medical

control prior to TOR

*Reminder*

Change

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