MILITARY PHARMACY AND MEDICINE

© Military Pharmacy and Medicine • 2012 • 4 • 74 – 76Such patients often suffer from substantial dehydrationand intravenous infusion of fluids isbeneficial.Mechanical ventilation is only considered whenall conservative methods fail. Decision regardingcommencement of mechanical ventilation shouldbe based on the degree of patient exhaustion, noton blood gas analysis. Noninvasive ventilationmay prevent the necessity of tracheal intubationand invasive mechanical ventilation.Achieving normal blood gas values duringmechanical ventilation can be difficult due tohigh airway resistance. It is sometimes necessaryto use special techniques of assisted ventilationwith patient sedation (e.g. using anesthetic gasesor ketamine).ResuscitationBLS and ALS rules apply during cardiac arrest.However, there are some additional requirements,which should be remembered: patientventilation is sometimes difficult due to high airwayresistance. Under such circumstances, ventilationwith a facemask is associated with highrisk of stomach distension. Therefore, it is importantto perform tracheal intubation early. Highairway pressures necessary to maintain properminute ventilation increase the risk of tensionpneumothorax. Prolonging inspiration and expirationtime is often necessary in order to avoidincrease in intrinsic end-expiratory pressure(i-PEEP or auto PEEP). Indirect cardiac massageis difficult or impossible in a patient with hyperinflatedchest. Prolonging the expiration timemay partially overcome this difficulty. If experiencedpersonnel is present, opening of thoraciccavity for direct cardiac massage should be considered.Arrhythmias are treated according tostandard therapeutic schemes.Traumatic injuriesCardiac arrest secondary to blunt trauma is associatedwith very poor prognosis. In cases of cardiacarrest after penetrating trauma, patient canbe sometimes saved if conditions for undertakingtherapy by personnel experienced in directcardiac massage (with opening of thoracic cavity)are met.Review articleCauses of cardiac arrest following trauma include:1) severe brain injury,2) hypovolemia due to massive blood loss,3) hypoxia secondary to respiratory arrest,4) direct injury to vital organs (heart or greatvessels),5) comorbidities (e.g. cardiac arrest in a driver,which preceded the traffic accident),6) tension pneumothorax,7) cardiac tamponade.ResuscitationEarly assessment and commencement of appropriateactions can prevent cardiac arrest. It isimportant to identify and undertake appropriatemanagement of life-threatening injuries as soonas they are diagnosed. Fast transport to a hospitalis crucial, as immediate surgery is often necessary.Rules of BLS and ALS in trauma patients arethe same as in cardiac arrest due to other causes.However, one should remember that: cervicalspine should be protected during restoration ofairway patency.It is important to exclude the presence of tensionpneumothorax. This complication may be indicatedby worsening lung compliance or hyperresonantpercussion sound. In such instance,pleural cavity should be immediately puncturedwith a needle (in the second intercostal space, inthe midclavicular line).Pulseless electrical activity (PEA) due to hypoxia,hypovolemia or both, constitutes the most commonmechanism of cardiac arrest in traumapatients. Therefore, administration of 100% oxygen,replacement of circulating blood volume orattempt at stopping the hemorrhage (direct compression,surgery) are necessary.Thoracic cavity can be opened in a small proportionof patients with penetrating chest traumaand PEA in order to commence direct cardiacmassage and simultaneous management of cardiactamponade and control of hemorrhage.Immediate and proper management of the discussedconditions can prevent occurrence of cardiacarrest. Resuscitation method may have to bemodified if cardiac arrest takes place in specialsituations described above.74 http://military.isl-journals.com