Ver el código de «Traumatic cardiac arrest»

==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==
*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 [[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==
*Emergency surgery

==See Also==
*[[Trauma (main)]]

==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/>

[[Category:Trauma]]
[[Category:EMS]]