The management of a cardiac arrest in trauma differs from the care of medical cardia arrest as the underlying pathophysiology is different. Cardiac arrest caused by severe blunt or penetrating trauma is commonly due to exsanguination or anatomic barriers. Individuals in traumatic arrest often present in PEA and have functional hearts that are impeded by severe blood loss or obstructions, like a pneumothorax or pericardial tamponade. Life-saving interventions such as bleeding control, fluid administration, and needle thoracostomy should be the priority. Ideally, we would replace the lost blood volume with blood products, but we utilize available crystalloids in our region. In contrast, epinephrine is a powerful vasopressor that stimulates the heart to beat faster and causes blood vessels to vasoconstrict; usually, this improves cardiac output, but in a patient with severe blood loss and an already maximally vasoconstricted vasculature, epinephrine has little or no benefit. Instead, prioritize airway support, fluid administration, reversal of suspected pneumothorax with needle decompression, Tranexamic Acid (TXA) administration, and transport to a Level 1 trauma hospital.
