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Traumatic Cardiac Arrest
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Bisman Jeet Kaur, Nidhi Bhatia
The commonest cause of pericardial tamponade is penetrating injury and requires immediate resuscitative thoracotomy via the clamshell technique or anterolateral approach. The important prerequisites for resuscitative thoracotomy are:Availability of an expert team in operating theatres that is well equipped to deal with the intraoperative findingsTime elapse between TCA and thoracotomy of no more than 15 minutes
Special Patient Situations
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
In children, cardiac arrest usually is not caused by ventricular fibrillation, and is often heralded by bradycardia, pulseless electrical activity, or asystole. The primary objective of resuscitation should be to correct the underlying cause (such as tension pneumothorax, hypovolaemia, hypothermia, or hypoxia). If return of spontaneous circulation is not achieved, resuscitative thoracotomy is indicated, however, the success rate in patients with cardiac arrest after blunt trauma is low.
Trauma in pregnancy
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
If the fundal height is below the umbilicus, there are no obstetric interventions which will improve outcome, so the focus is on the standard management of a traumatic cardiac arrest (12). This includes intubation and ventilation; bilateral thoracostomies; reduction and splintage of long bone fractures and pelvic fractures; arrest of major external haemorrhage and intravenous or intraosseous access with fluid resuscitation, ideally blood. It also includes consideration of a resuscitative thoracotomy in the case of penetrating chest trauma (13).
Prehospital Pericardiocentesis Using a Pneumothorax Needle
Published in Prehospital Emergency Care, 2022
Aaron E. Robinson, Gregg A. Jones, Paul C. Nystrom, Adam Stirling, Kelsey Vanderbosch, Nicholas S. Simpson
Prehospital resuscitative thoracotomy is increasingly becoming recognized as a viable treatment modality for penetrating traumatic cardiac arrest, especially for injuries resulting from stab wounds. In the United Kingdom and parts of Europe, where a physician field response is commonplace, resuscitative field thoracotomy can be an effective and life-saving intervention (7–10). Given there was an EMS Physician on scene, resuscitative thoracotomy in the field was considered. However, there were several factors favoring pericardiocentesis that were specific to this case. Transport time to a fully equipped trauma resuscitation bay was short (approximately 3 minutes). Our service does not carry blood products prehospital and there was concern that through opening the chest, the patient would be put at risk of exsanguination. In addition, the EMS Physician did not have the ideal equipment immediately available to perform a resuscitative thoracotomy in the field.