1910 TRAUMATIC
ARREST UPDATE
PITKIN COUNTY EMTAC
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
Injuries incompatible
to life?
Do not start CPR
0050 Field Pronouncement
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
*Added: Contact medical
control prior to TOR
Change