Traumatic cardiac arrest

• start with DRcABC

• work on your reversible causes (4H’s & 4T’s) focusing on hypoxia, hypovolemia, tension pneumothorax, tamponade

low output state of trauma - unconscious, not breathing , no pulse but electrical activity

no output state in trauma

HOTT principle

• Hypovolaemia

  • control external and internal haemorrhage

  • on the floor and 4 more: chest, abdo, pelvis, long bone

  • controlled by - direct pressure, torniquets, blast bandages, limb traction, pelvic binders , fluids ( large bore IV or IO) - not causes bp over 80 mmHg

• Oxygenation

  • Consider C-spine, but airway take priority

  • jaw thrust

  • Impact brain apnoea ( blow to head causing immediate stop of breathing) if breathing doesn't resume quickly the hypoxia leads to an arrest

• Tension pneumothorax

  • air enters the plural space increasing intrathoracic pressure causing a lung to collapse

  • treated either needle chest decompression

• Tamponade

  • Penetrating trauma- need hospital treatment / hems as soon as possible as they need a thoracotomy within 10 mins of loss of cardiac output.

  • finger thoracotomy and resuscitative thoracotomy (clam shell)