Traumatic cardiac arrest is cardiac arrest caused by injury, most often from massive bleeding, tension pneumothorax, low oxygen or cardiac tamponade. Unlike a medical arrest, fixing these reversible causes matters more than chest compressions.
Key symptoms
- No pulse and no normal breathing after an injury
- Major external bleeding
- Penetrating wound to the chest or abdomen
- Blunt trauma from a crash or fall
- Pulseless electrical activity on the monitor
What you find on exam
- Rapid check for massive bleeding
- Airway and breath sounds
- Chest: wounds, deformity, absent breath sounds
- Signs of obvious death, such as injuries incompatible with life
- Monitor rhythm and capnography
Tests
- Ultrasound, if trained, for tamponade and cardiac activity
- End-tidal CO2
- Rhythm check
- Time of injury and time of arrest
Treatment basics
- Stop bleeding first: tourniquets, wound packing, pelvic binder
- Open the airway and ventilate with oxygen
- Needle decompression of both sides of the chest for possible tension pneumothorax
- IV or IO fluids, or blood if available
- Rapid transport to a trauma center; consider stopping per protocol
Red flags
- Penetrating chest trauma: may need emergency thoracotomy
- Short transport time to a trauma center
- Arrest witnessed by EMS
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); AHA Guidelines for CPR and ECC. Written by Making Synapses. Making Synapses is not affiliated with these organizations.