Trauma code

VFFforpeople

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So went to a call for a PT how crashed his motorcycle. Had Left vent collapse and damage to his pelvis. (found out from Dr. also ran search didnt see this). As a medic how would you handle this? CPR was not really effective, got a pulse back, and HR went to 40 at one point. He was down 11min up transport.
 

spisco85

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Am I the only one not understanding all of this? Personally, I would want to know more about the call. Was he alive when you got there and then coded? Was he "dead" before you got there?

By "left vent collapse" do you mean left lung? Why was CPR ineffective if you got pulses back?

Can you explain the call a little more?
 

Dwindlin

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While I don't quite understand what you're saying either, I will say this. Speaking in generalities trauma arrests do not do well. I worked in a rural area for several years and our protocols were blunt arrest you didn't initiate resuscitation unless they could be deleveried to a trauma center within 5 minutes, and it was 15 minutes for penetrating trauma. Needless to say this was impossible in my area, so we worked almost no traumatic arrests unless we had a strong suspicion it was an arrest that caused the accident.
 

Melclin

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Yeah I really have no idea what that post was getting at. If the arrest is going to be worked then its:

-Compressions/ventilations 30:2 until advance airway is in situ when it becomes 15:1.

-Airway management: suction and intubation. NG tube to remove stomach contents and the inevitable bucket of misdirected air.

-Fluid - IV access + however much fluid is appropriate. 20mls/kg for PEA seems to be the go around here, but with a broken pelvis as well I'd imagine that we'd just poor fluid in by the bucket load.

-Auscultate chest during vents, looking for signs of tension pneumothorax which would most probably be fairly unreliable. Probably pop the chest anyway. First with a 14g cannula, and then set up for pnemo cath insertion.

Treating you H&Ts is the priority here but there's so much wrong with the trauma arrest pt that we can't do anything about - which is why the outcomes are so poor.

Definitive treatment is surgery and even then its pretty much a lost cause. The reason we don't transport trauma arrests unless we get a ROSC is because of a big study that provided a very high level of evidence for almost universally bad outcomes for pts presenting in asystole or PEA less than...40 I think it was. I can't remember which one it is exactly but there are a few big position papers kicking around out there that say you should work trauma arrests in the field at the ALS level.
 

Aidey

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-Compressions/ventilations 30:2 until advance airway is in situ when it becomes 15:1.

In the US once an advanced airway is in place usually* compressions are constant, with breaths delivered every 6-10 seconds (*depends on local protocol).
 

MrBrown

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I don't really understand what you're on about either mate that grammar is atrocious.

If he's got bad breath sounds on the left either he's got a PTx, some sort of PE (unlikely but possible) or a heamothorax.

Treatment would be CPR and IV access, run a bag of saline, adrenaline and H&Ts ... pretty much as Melclin said

Unless we get quick ROSC, say about 10 minutes, I'd stop because this guy is a goner.
 
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VFFforpeople

VFFforpeople

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Sorry I should have made it more clear. Left ventrical collapse, Pevilc damge from the handelbars. Dead when we went to scene, cpr was in progress when we got there. Blood was coming from ears and nose while pumping on him. ALS went to scene about 10min into CPR. HR came back while in the truck, then lost..Then one more time upon arrival HR=40, then lost it.
 

Melclin

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In the US once an advanced airway is in place usually* compressions are constant, with breaths delivered every 6-10 seconds (*depends on local protocol).

Yeah compressions are constant here too. The idea is that every 15 compressions you vent, but you don't stop the compressions. It works out to a little over 6 vents a minute. That's the official baseline guide, but usually you would modify for more or less depending on the particulars of each situation.

When you say ventricular collapse, do you mean that which is caused by cardiac tamponade? If so then the pt is pretty much stuffed. A CT that has progressed to arrest = a dead pt (unless you happen to be a hop, skip and a jump away from a conveniently placed trauma centre). Our ALS units can't do pericardial centisis (forgive my spelling and terminology, I've been enjoying an evening of Tasmanian beer). I'm not sure about the chopper medics. I don't think they can, and if that's true that's just plain stupidity. They have the ultra sound equipment, and more experience than half the bloody doctors doing that procedure..not to mention the necessity of the situation given that they'd be a long flight from the right facilities most of the time.

Even with the PC, a traumatic cardiac tamponade is caused only by things that are bad. If you needled the heart, I suspect the problem would soon return...and in greater numbers B) just like sand people.
 

Aidey

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Ahhh, ok. I thought you were saying compressions are stopped like in CPR without an advanced airway.

Did he actually have a pulse, or was there just electrical activity on the monitor? ie. PEA.
 

firetender

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Yes, you can get the body back now and again, but under the circumstances (and here's what you really need to work on - making sure you paint an accurate and thorough picture for us so we don't have to ask twice. Use this forum to practice) PROBABLY no chance.

AND NOT ONE MEDIC ASKED THE MOST IMPORTANT QUESTION...
Was the guy wearing a helmet?

AND NOT ONE MEDIC COMMENTED ON "BLOOD COMING FROM EARS AND NOSE WHILE PUMPING..."

Those little pieces of knowledge, taking just a little further examination, would define the actions taken on the call.
 

maxwell

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I'd treat it like any other traumatic arrest.
Bilateral 14's, an ETT, CPR, Epi, Atropine, Calcium.
:excl:(For the one medic I'm thinking of that will want evidence -and who is out to get everything I say: there's evidence out there for Calcium in traumatic arrests, I've read it and participated in it - just too tired to search for it now) :excl:

LV collapse...not diagnosable in the field without doing a thoracotomy (yay!) and/or an ultrasound. Either way, it won't change your mgmt. Pelvic fracture is where you're losing a lot of your volume (I'd say 1/2 chest, 1/2 pelvis) - so VOLUME VOLUME VOLUME. The meds aren't really important since the arrest really isn't cardiogenic in origin.

Remember, the beatles said it best "you can't save someone who can't be saved"
 

MSDeltaFlt

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So went to a call for a PT how crashed his motorcycle. Had Left vent collapse and damage to his pelvis. (found out from Dr. also ran search didnt see this). As a medic how would you handle this? CPR was not really effective, got a pulse back, and HR went to 40 at one point. He was down 11min up transport.

How would I treat a traumatic arrest from blunt trauma? 3 leads and a sheet.
 

Akulahawk

EMT-P/ED RN
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Sorry I should have made it more clear. Left ventrical collapse, Pevilc damge from the handelbars. Dead when we went to scene, cpr was in progress when we got there. Blood was coming from ears and nose while pumping on him. ALS went to scene about 10min into CPR. HR came back while in the truck, then lost..Then one more time upon arrival HR=40, then lost it.
If the patient is VSA on scene, in the setting of trauma, PEA < 40 or asystole in 2 leads, the patient gets treated with a sheet. I don't care if BLS is doing CPR, I'm going to apply the monitor, stop CPR to see if there's an underlying rhythm... none seen... adios.

Around here, if we see PEA > 40 or any rhythm other than asystole... and the patient doesn't fit any other determination of death criteria, we're supposed to work the patient. That's bilat large bore IV's... and treat the presenting rhythm...

From what I've seen, a dead trauma patient tends to stay dead, no matter what you do for (or to) them.
 

EMSLaw

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Sorry I should have made it more clear. Left ventrical collapse, Pevilc damge from the handelbars. Dead when we went to scene, cpr was in progress when we got there. Blood was coming from ears and nose while pumping on him. ALS went to scene about 10min into CPR. HR came back while in the truck, then lost..Then one more time upon arrival HR=40, then lost it.

We regret to inform you that your patient is dead.

Blood coming from ears and nose? Down more than 10 minutes before transport? Multiple arrests?

I'll probably get a lot of heat for saying this, but this is a lost cause.

I'm curious, did he make it to the hospital alive?
 

MrBrown

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Well now that i saw that heck I probably wouldn't work this guy, sorry dude, you're toast
 

Epi-do

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Traumatic arrests stay dead. No reason to even begin to work this guy, at least not with the protocols I have.
 

JeffDHMC

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Blunt trauma arrests w/o V/S when you get there...dead. The monitor should have no bearing on your descision to pronounce.
 
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VFFforpeople

VFFforpeople

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Ahhh, ok. I thought you were saying compressions are stopped like in CPR without an advanced airway.

Did he actually have a pulse, or was there just electrical activity on the monitor? ie. PEA.

It was PEA, then got it to 40 beats a min, then lost it 15sec or so after that. It was a tamponede (forgive my spelling tired). Yes full face helmet, and protective riding gear. Got the full report today. Basil skull FX with hemorphage (again spelling, tired). So, there was nothing to be done.
 
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VFFforpeople

VFFforpeople

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We regret to inform you that your patient is dead.

Blood coming from ears and nose? Down more than 10 minutes before transport? Multiple arrests?

I'll probably get a lot of heat for saying this, but this is a lost cause.

I'm curious, did he make it to the hospital alive?

No, he was DOA
 
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