Prehospital Pulseless, Unconscious Penetrating Trauma Victims

Abstract

Functional survival was rare but did occur with penetrating trauma presenting pulseless and unconscious in the out-of-hospital setting. Although the presence of a pulseless sinus rhythm or tachycardia and stabbing as a mechanism seemed to indicate better survival rates, our study failed to identify reliable out-of-hospital criteria to separate salvageable penetrating trauma victims from those who are nonsalvageable. With this lack of reliable criteria, aggressive prehospital resuscitation efforts and rapid transport to the nearest trauma center for pulseless, unconscious victims of penetrating injury seem indicated.

Field Triage of the Pulseless Trauma Patient

“…1 Initial reports on the use of resuscitative thoracotomy in the emergency department (ED) seemed to hold some promise for injured patients with cardiopulmonary arrest (12%-20% survival rate) [2][3][4] ; however, in spite of advances in medical care, most recent reports indicate that trauma patients requiring cardiopulmonary resuscitation (CPR) have a dismal prognosis (survival rate, 0%-5%). [5][6][7][8][9][10][11] This abysmal survival rate has led to a less aggressive resuscitative approach and a more restricted use of resuscitative thoracotomy in trauma victims presenting in cardiopulmonary arrest. Many patients are now pronounced dead on arrival shortly after reaching the ED.…”

Prehospital Procedures Before Emergency Department Thoracotomy: “Scoop and Run” Saves Lives

“…Although evidence is quite clear that prehospital procedures such as endotracheal intubation and intravenous (IV) line placement benefit rural blunt trauma victims with prolonged transportation time, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] data are less convincing for critical patients with penetrating injuries in the urban setting who are rapidly transported to the hospital. [15][16][17][18][19][20][21] We theorized that prehospital healthcare personnel are performing more procedures in the field today, thereby delaying arrival to the hospital and the administration of definitive care-namely emergency department thoracotomy (EDT) and surgery.…”

Does the prognosis of cardiac arrest differ in trauma patients?*

“…Despite advances in medical care, survival rates of 0% to 2% have been consistently reported for blunt trauma patients who arrive at a trauma center with no signs of life (2)(3)(4)(5)(6). Unfortunately, many of these survivors experience severe permanent neurologic disability (5,7).…”