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Mon Aug 10 14:31:40 BST 2009

If you will look at the PreHosptial Trauma Life Support Course in the
Assessment, Shock and Thoracic chapters you will find the details. 
Also look at the position paper on the indications of non resuscitation
of the prehospital trauma patient by the ACS and NAEMSP published in
March ( I believe) 2003 for the Journal of the American College of
Surgeons.

However, A brief explanation is: cardiac arrest of the medical patient
is secondary to a rhythm problem that is potentially correctable by
re-establishing a functional rhythm. That is achieved by defibrillation
and maintained by various drugs. 
On the other hand cardiac arrest in a trauma patient is loss of blood
volume to be pumped through the lungs to be oxygenated and hence to the
cardiac muscle to provide ATP (energy) production by the cardiac muscle.
This is only treatable be replacement of the lost blood volume. That
cannot be done in the field . This patient is non survivable and
resuscitation should NOT be attempted.

Although there are benefits to chest needle decommission in the field on
some patients, this is not one of them. 

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Keith Carter
Sent: Monday, August 10, 2009 8:18 AM
To: trauma-list at trauma.org
Subject: Blunt Trauma

Pre- Hospital Cardiac Arrest due to blunt trauma.  Is Standing Order for
bilateral needle decompression by paramedics warranted and justified?
Why or why not ?

paramedicmd at msn.com

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