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Current Emergency Medical Services Guidelines: Traumatic Cardiopulmonary Arrest And Prehospital Airway Management (Trauma CME)

January 2012

Abstract

In this edition of EM Practice Guidelines Update, 2 clinical guidelines addressing critical aspects of emergency medical services (EMS) systems and their applicability to the emergency department (ED) are reviewed. The first guideline addresses termination of resuscitation and prognostic factors in traumatic arrests. The second guideline examines the management of airway emergencies in the prehospital setting, with a focus on the use of supraglottic airway devices (SADs). This issue of EM Practice Guidelines Update aims to enhance the transition of patient care between prehospital providers and the ED. Emergency clinicians interact with EMS providers at multiple levels— at the bedside in the ED, in the field by medical control, and as directors of EMS systems. As prehospital systems continue to develop and expand their scope of practice, it becomes increasingly important that EMS deliver evidence-based interventions.

Practice Guideline Impact

  • Initial electrocardiograph (ECG) rhythm and duration of resuscitation are prognostic markers that help determine the salvageability of the trauma patient.
  • In cardiac arrest caused by blunt trauma, resuscitation should be withheld in patients without vital signs. In penetrating trauma, if vital signs are absent, prehospital providers should assess patients for other signs of life prior to terminating resuscitation.
  • The laryngeal tube (LT) should replace the Combitube® as the primary rescue device for prehospital providers because of the ease in acquiring and maintaining the skills for using the LT, and because of its overall lower complication rate.
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