traumatic arrest algorithms

[kmattox at aol.com]

The issue are legal and medical control.     Most states and provences prohibit medics from pronouncing a person dead and once started CPR is continued till handed over to a hospital even though the medics and EMTS know it is futile.  

K


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-----Original Message-----
From: "oded private" <tangentcarrot at hotmail.com>
Date: Fri, 10 Nov 2006 23:08:30 
To:trauma-list at trauma.org
Subject: traumatic arrest algorithms

Hi

A few months ago we discussed the role of CPR for pre hospital traumatic 
arrest, and I believe it was broadly agreed that we don't know of any 
evidence showing any positive affect for CPR in traumatic arrest. On the 
other hand, there is good physiolgic sense that it is not only futile but 
might have a theoritical risk of lowering the salvage rate of ED thoracotomy 
due to prolongation of transfer and further exshanguintaion with 
compressions.
Still, it seems to me that many EMS systems do practice close chest CPR for 
traumatic arrest. I see it here in Israel and I also see it in documentary 
TV from the US.
Surgeons- how is it done in your province? What algorithm is the best to 
your opinion?
Same goes for mandatory ET intubation in the field for all traumatic arrest 
victims or victims in extremis (profound shock) vs. bag-valve-mask 
ventilation.
By the way, even the book "trauma" offers an algorithm that mandates ET 
intubation in the field and chest compressions en route to the ED for all 
traumatic arrest victims who still have an EKG rhythm, given transfer time 
does not exceed 10 min.

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