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Is Coding of Penetrating & Blunt Trauma Arrest Patients Warranted?

Slovis-topic-brought-significant-comments-from-attendin-Medical-Directors

Corey Slovis, MD, FACP, FACEP, FAAEM, reported results of a recent survey 32 of his Eagle colleagues participated in regarding their coding/resuscitation of traumatic cardiac arrests and told the Eagles at the Eagles conference that he feels a position paper is warranted to reduce or stop the unnecessary resuscitation of selected, severely traumatized patients.

Slovis is a professor of emergency medicine and medicine and chairman of the department of emergency medicine at Vanderbilt University Medical Center in Nashville. Slovis serves as the medical director of the Nashville Fire Department, the NFD Paramedic/EMS Bureau and the Nashville International Airport.

He pointed out that at least one article in a noted emergency medicine journal recommended that crews perform up to 15 minutes of CPR before code pronouncement. His question was: Why are we doing resuscitation on patients who have no blood circulating in their systems? He also noted that research has showed little benefit of epinephrine in medical cases, let alone a traumatic cardiac arrest.

The results of Slovis’ Eagle survey showed that 1/3 of the respondents’ systems still coded blunt and penetrating trauma codes with limited resuscitative success.

Slovis reported that research has shown that, even though a small number of patients in traumatic cardiac survive, 75% of them have significant neurological deficits and reduced quality of life.

Eagles leader Paul Pepe, MD, pointed out that there are circulatory traumatic cardiac arrests and patients who survive the trauma but succumb to cardiac-related arrest.

An article in Resuscitation recommended that field crew confronted with traumatic cardiac arrest should:
• Try to control hemorrhage;
• Splint the pelvis/fractures; and
• Manage airway and oxygenate.

The Eagles group agreed that a position paper should be developed in a careful and deliberate manner, noting that crews have to consider many variables before the termination of CPR, including initial findings and age of the patient.

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