My message – don’t do cpr on a traumatic arrest caused by penetrating trauma to the torso. You are accomplishing nothing by pressing on the patient’s chest. The patient has bled to death, and it is unlikely that you are sending blood to the brain when you do cpr. If anything, you may be making the injuries worse.
Trauma is all about stopping the bleeding. In this scenario, your choices are (1) do a thoracotomy (or thoracotomy-laparatomy), (2) perform standard cpr, or (3) pronounce the patient. Only one of these options is likely to result in a patient walking out of the hospital, and that’s option (1). EM docs have varying opinions on whether we should be doing thoracotomies. I am a yes-thoracotomy person. You just have to save one to feel good about yourself for the rest of your life.
Don’t do compressions. Don’t defibrillate the heart. Open the chest. If you don’t know how to open the chest, you will likely do cpr, and later, pronounce the patient. There’s nothing wrong with that. You’re not expected to be a hero.
Intubate the patient, put in big lines, transfuse blood and blood products, perform a left-sided thoracotomy, put a chest tube into the R side. All of these things should happen simultaneously in a trauma center. If I am alone with a single nurse, I perform the tasks more or less in the above order. If I have a couple of nurses, I do the thoracotomy first (the nurses can bag the patient and put in IVs).
Traumatic arrests from bullets to the chest seldom make it because the injuries are typically devastating. Traumatic arrests from knives have a better chance because the injuries may be isolated and operable.
Our patient arrived with an et tube, a c-collar, and an IO. That is time wasted in the field and it’s bad practice imho. All gsw patients should be scoop-and-run.
We did all of the above simultaneously. When the left chest was opened, a ton of clots came out of it. The heart was shot up and empty. Nothing came out of the R chest. When blood started to go in, there was bleeding from a lung, the heart (which was stapled), and a coronary. We couldn’t restart the heart, however, likely due to the bad cardiac injury and the exsanguination. We tried.