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Thu Dec 21 08:34:35 GMT 2006

I would take the view that if there is no immediate reversable cause
(such as airway obstruction) then cardiac arrest from isolated head
injury is fatal, so I would not treat.

In practice it would depend on how certain I was of the situation. For
example a head injured patient who suddenly arrives unintubated and in
cardiac arrest I would treat while making an assessment of the situation
(primary survey critical interventions only). In contrast if the patient
had been in the ER for a while and I knew that there was isolated TBI
and no reversable cause I would do no interventions, other than care for
the relatives and discuss with them the possibility of cadaveric tissue
donation.

I am an enthusiast for ER thoracotomy in the right cases, however even I
can see absoutely no reason why anyone would open a chest in a patient
with cardiac arrest due to brain injury, it would simply be an exercise
in futility.

Tim. Coats.

-----Original Message-----
From: oded private [mailto:tangentcarrot at hotmail.com] 
Sent: 19 December 2006 16:48
To: trauma-list at trauma.org
Subject: head injury- termi ation of resuscitative efforts

Hello list

I'd like to hear your opinion about deciding to terminate treatment for
isolated TBI resulting in cardiac arrest.

What if the pateint is still in PEA? Will you attempt to defibrilate VF,
if it happened for some reason?

If you do treat him- what will you do?  ET intubation and ventilation
alone? 
CPR? Does anybody here practice thoractomy in the scenario and is ready
to "come forward" and admit to it?

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head injury- termi ation of resuscitative efforts