BLS for Trauma Patients

Cardiac arrest in trauma patients presents unique challenges, including spinal injuries, severe bleeding, and airway compromise. Healthcare providers must adapt their approach to ensure effective resuscitation while minimizing further harm.

Key Challenges in Trauma Resuscitation

• Spinal Injuries: Trauma patients may have cervical spine damage, requiring modified airway maneuvers.
• Hemorrhagic Shock: Uncontrolled bleeding can cause hypovolemic cardiac arrest, making hemorrhage control a priority.
• Chest Trauma: Conditions such as pneumothorax and rib fractures can impair breathing.

How to Modify BLS for Trauma Patients

1. Airway Management: Spinal Precautions

• Assume spinal injury in all unresponsive trauma patients until proven otherwise.
• Use jaw thrust maneuver instead of head tilt-chin lift to open the airway.
• Ensure cervical spine stabilization if spinal injury is suspected.

2. Chest Compressions in Trauma

• Perform compressions at 100-120 per minute, maintaining a depth of at least 2 inches (5 cm).
• For trauma patients with severe chest injuries (e.g., rib fractures, flail chest), compressions may be less effective but should still be performed.
• If the trauma is due to penetrating chest wounds, rapid surgical intervention (e.g., thoracotomy) may be necessary.

3. Managing Hemorrhagic Shock

• Uncontrolled bleeding is the most common preventable cause of death in trauma-related cardiac arrest.
• Prioritize severe hemorrhage control:
  • Apply direct pressure to control external bleeding.
  • Use tourniquets for limb injuries (if bleeding is life-threatening).
  • Consider wound packing with hemostatic dressings for junctional bleeding (e.g., groin, axilla).
• If possible, initiate massive transfusion protocols in hospital settings.

4. Recognizing and Managing Chest Trauma

Trauma patients may develop life-threatening chest injuries that impair breathing.

• Pneumothorax (Collapsed Lung): Watch for signs such as:
  • Absent breath sounds on one side.
  • Tracheal deviation (late sign).
  • Distended neck veins (in tension pneumothorax).

  Treatment: Needle decompression or chest tube placement (performed by advanced providers).

• Flail Chest: Multiple rib fractures cause paradoxical chest movement (one side moves opposite to the other).

Treatment: Provide oxygen and assist ventilation; consider early intubation.

Key Takeaways: BLS for Trauma Patients

• Use jaw thrust maneuver to maintain airway in suspected spinal injuries.
• Perform chest compressions even if trauma-related injuries make them less effective.
• Control severe hemorrhage using direct pressure, tourniquets, or wound packing.
• Monitor for life-threatening chest injuries (pneumothorax, flail chest) and prepare for advanced interventions.

Adapting BLS for trauma patients requires quick decision-making and specialized techniques to prevent further injury while maximizing survival chances.

Next, we’ll discuss how to recognize and manage cardiac arrest in opioid overdose, a growing cause of emergency resuscitations.