CPR on Trauma Patients

[adventure_rn, MSN, NP]

I'm hoping to pick the brains of some trauma/SICU nurses. I work exclusively in NICU, but I was completing some modules through the AACN website and had a random question about adults and trauma.

One of the case studies involved an 18 yo in a motorcycle accident with severe crush injuries to the chest, GCS of 3. They mentioned in the presentation that the patient required resuscitation on arrival, and it got me thinking...can you even do chest compressions on a patient with severe traumatic injuries to the chest wall? I know that the act of compressions itself can cause fractures, but it seems as though applying force to all of those loose bone fragments could cause even further bleeding and damage.

Like I said, adults are totally out of my comfort zone, so I'd be curious to hear insights from nurses who actually work with this patient population. Thanks!

[Rose_Queen, BSN, MSN, RN]

Someone undergoing CPR is already dead. Can't make them any deader by doing the CPR, even if those hypothetical loose bone fragment might cause injury- but can give them a chance to make it to the point of surgery or definitive care.

That's what we say about the patients we don't have time to do more than dump a bottle of betadine over instead of a true quality prep- we hope they live long enough to get the infection.

[PeakRN]

In the world of trauma he has a very low chance of survival. Bilateral chest tubes/finger thoracostomy, address external bleeds, resuscitate fluids as appropriate, secure the airway, and if there isn't any progress in rhythm or return of circulation call it. If you think about all of the force that caused multiple rib fractures, they also probably cause cardiac and pulmonary contusions, injury to the CTLS, and most likely a pretty severe insult to the CNS.

You could do a thoracotomy (and then do cardiac massage) but statistics show that blunt injury arrested trauma patients do not benefit from this.

[adventure_rn, MSN, NP]

Thanks for sharing, guys. I learn so much on this site.

[PaSSiNGaS, MSN]

Just make sure when you transfer him over from the ER stretcher to the ICU bed that you already have the body bag underneath. It will save you some moving at the end of the shift.

[adventure_rn, MSN, NP]

You could do a thoracotomy (and then do cardiac massage) but statistics show that blunt injury arrested trauma patients do not benefit from this.

I just watched another AACN module which presented a different case (penetrating knife wound to the chest cavity rather than a crush injury), and they discussed the advantages and drawbacks of thoracotomies. Fascinating stuff.

If anybody here is a member of the AACN, I highly recommend this CEU module. The subject matter is very interesting, and I found the speaker quite entertaining:

After the Golden Hour: Resuscitation and Management Challenges of Trauma Patients in Critical Care

https://www.aacn.org/education/ce-activities/nti16174/after-the-golden-hour-resuscitation-and-management-challenges-of-trauma-patients-in-critical-care

[akulahawkRN, ADN, RN, EMT-P]

Dead patients in the setting of blunt trauma invariably stay dead. Penetrating trauma has a small chance of survival but that depends upon very quickly achieving hemorrhage control. I agree with putting a body bag on the gurney before moving the patient over to it, at least in the setting of blunt trauma, because it will save you time and energy in having to roll the body from side to side in order to get the bag under the patient. Of course having the body bag in place already does present a bit of a poor optics problem... it does look bad.

[brownbook]

Agree with all. Wonder if the slight possibility the patient could end up an organ donor makes at least an attempt at ACLS worth the effort.