Cardiac arrest and trauma exception


One thing that I learned as a resident in emergency medicine is that when a patient has cardiac arrest after a car crash, motorcycle crash or some other major trauma, those people are not going to do well.

In fact, it is rare for them to survive.

Of course, there are exceptions. One such patient was the victim of a high speed motorcycle crash into a large tree. When paramedics got to him, he was essentially dead. No pulse, no breathing. They got him intubated, started CPR, and headed toward the ER. Surprisingly, on arrival, he had regained a strong pulse and blood pressure. It was speculated that when he crashed, he was knocked unconscious, and because of how his body was positioned, he could not breath, perhaps because his face was against the ground, or something was pushing on his airway. Instead of developing cardiac arrest because of severe bleeding, head injury, etc, he had suffered a respiratory arrest, which was correctable. He ended up recovering, and proving there is always an exception to the rule.

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{ 2 comments… read them below or add one }

Rogue Medic 02.04.09 at 3:37 am

A Straight Dope Classic from Cecil’s Storehouse of Human Knowledge
What’s the meaning of the expression, “That’s the exception that proves the rule?”

A pet peeve. :-)

This is not an exception proving any rule. It is an indication that a good assessment should identify the lack of fatal trauma to the patient. The trauma arrests, who survive, are almost always isolated puncture wounds. The resuscitation of this patient seems to prove, as you stated, that this was probably not a trauma arrest. if it is not a trauma arrest, it is not an exception.

good post. People need to be reminded to assess more thoroughly than just looking at the patient and jumping to conclusions.

Nurse K 02.08.09 at 9:26 pm

Local medic protocols are that if a patient is found to be in asystole following a car accident or other obvious major trauma situation that all that is done is to open the airway. If the patient doesn’t regain a pulse, no CPR is done.

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