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Management of the Pulseless Patient in the Trauma Bay2020

Type: New Practice Management Guideline (PMG)
Category: Trauma
Committee Liaison: Jennifer J. Freeman, MD

Team leader(s)

EAST has previously published a practice management guideline (PMG) for the evidence-based approach to patient selection for emergency department thoracotomy (EDT).[1] These guidelines use presence or absence of signs of life, mechanism of injury (blunt or penetrating), and anatomic injury pattern (penetrating thoracic versus penetrating extrathoracic) to make recommendations about use of EDT. Signs of life, previously defined by the American College of Surgeons Committee on Trauma, include any of the following: pupillary response, spontaneous ventilation, presence of carotid pulse, measurable or palpable blood pressure, extremity movement, or cardiac electrical activity.[2] In clinical practice, many trauma surgeons have bedside adjuncts available in the trauma bay which may also guide their patient selection for EDT. For example, Focused Assessment for the Sonographic examination of the Trauma patient (FAST) for presence or absence of cardiac wall motion and/or pericardial fluid as well as type of cardiac electrical activity (pulseless electrical activity, wide complex tachycardia, asystole) may inform patient selection. The purpose of this new PMG is to systematically evaluate the literature and grade the quality of the evidence for use of cardiac ultrasound and type of cardiac electrical activity for patient selection for EDT. 1. Seamon MJ, Haut ER, Van Arendonk K, et al. J Trauma Acute Care Surg. 2015;79:159-173. 2. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons. Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg. 2001;193:303Y309.

Team members:
George Kasotakis, MD, MPH
John Como, M.D., M.P.H.
Jonathan Nguyen, D.O.
Anna Goldenberg-Sandau, D.O.
Sofya Asfaw, M.D.

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