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Vasopressors in prehospital traumatic arrest

McSwain, Norman E nmcswai at tulane.edu
Wed Dec 1 23:31:00 GMT 2010


I found this one. There was one with when the RT was started and Rx
prior. Not sure where it was published. I am still looking

Norman
Norman McSwain MD, FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
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 caesar ursic
Sent: Wednesday, December 01, 2010 5:30 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Vasopressors in prehospital traumatic arrest

Dr. McSwain - is this the paper?

*Stockinger ZT, McSwain NE Jr. Additional evidence in support of
withholding
or terminating cardiopulmonary resuscitation for trauma patients in the
field. J Am Coll Surg. 2004 Feb;198(2):227-31.*
**
*BACKGROUND: Survival for trauma patients who receive prehospital
cardiopulmonary resuscitation (CPR) has been reported as poor. We
assessed
the survival for prehospital CPR in our trauma system and attempted to
find
prehospital predictors of mortality.*

*STUDY DESIGN: We conducted a retrospective review of our Level I trauma
center's database that identified 588 patients over a 6-year period
(January
1, 1997, to December 31, 2002) who received prehospital CPR. Mechanisms
of
injury, prehospital vital signs, and survival to discharge were
analyzed.*

*RESULTS: Twenty-two of 588 patients (3.7%) survived to hospital
discharge.
Overall, 60.7% did not survive to achieve hospital admission, and an
additional 32.6% died on the first hospital day. Patients with
penetrating
injuries had a significantly lower survival rate than those with either
blunt or other (eg, drowning, hanging) injuries (0.9% versus 6.2%, and
13.2%, respectively, p < 0.001) and significantly lower Revised Trauma
Scores (RTS; mean +/- SD: 0.32 +/- 0.96 versus 0.76 +/- 1.84 and 1.18
+/-
2.51, respectively, p < 0.05.) The likelihood of survival with RTS = 0
was
less than 1% overall, and 0% for penetrating trauma.*

*CONCLUSIONS: These findings add support to recent guidelines regarding
the
termination or withholding of resuscitation for trauma patients in the
prehospital setting. Victims of penetrating trauma with a prehospital
RTS =
0 (combination of no respiratory rate, no systolic blood pressure, and a
Glasgow Coma Score of 3) should be declared "dead at the scene."*





On Wed, Dec 1, 2010 at 1:17 PM, McSwain, Norman E
<nmcswai at tulane.edu>wrote:

> Sorry I cannot put my hands on the paper right now
>
> Norman
> Norman McSwain MD, FACS
> Professor, Tulane School of Medicine
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
> 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 McSwain, Norman E
> Sent: Wednesday, December 01, 2010 5:12 PM
> To: Trauma-List [TRAUMA.ORG <http://trauma.org/>]
>  Subject: RE: Vasopressors in prehospital traumatic arrest
>
> Zsolt Stockinger when he was a trauma fellow here looked at
> Resuscitative Thoracotomies in the ED. Although I put my hands on the
> paper right now, It is my memory that he found that delayed
thoracotomy
> (>5 minutes) or any type of ACLS drugs were both negative predictors
for
> survival.
>
> He is in Afghanistan right now. Z if you are lurking what were your
> actual data?
>
> Norman
> Norman McSwain MD, FACS
> Professor, Tulane School of Medicine
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
> 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 caesar ursic
> Sent: Wednesday, December 01, 2010 4:01 PM
> To: Trauma-List [TRAUMA.ORG <http://trauma.org/>]
> Subject: Vasopressors in prehospital traumatic arrest
>
> What, if any, is the role of epinephrine or atropine (the "typical"
ACLS
> cardiac arrest drugs) in prehospital traumatic arrest?
> Do you approach the 35 year old who has had 15 mins of prehospital CPR
> after
> falling off a third story balcony (because he was found "pulseless and
> bradycardic" at the scene) once he arrives in your ER any differently
if
> he
> has / has not received multiple doses of epi and atropine (assuming
that
> the
> patient is still pulseless but has some sort of ECG rhythm on
arrival)?
> Just curious.
>
> CM Ursic, MD
> Honolulu
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