Traumatic Arrest Scenario

Question 1 of 16

1. Question

You should …

Liaise with control or any other police to confirm if the scene is safe and you can approach

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Follow the armed response cars to scene as the patient will probably need life-saving treatment

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Question 2 of 16

2. Question

You see an unarmed police vehicle ahead who has started to block the road and ask the question. He relays from armed response that the assailant is still at scene so they will call you forward once safe. He states there is one male patient, unconscious and has been run over by a car. You start to fear the worst and start looking at your HOTT principles for traumatic arrest. What does HOTT stand for?

Hypovolaemia

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Oxygenation

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Tension pnuemothorax

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Tamponade

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Hypoxia

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Hypoglycaemia

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Question 3 of 16

3. Question

Are there any traumatic aetiologies of arrest where a normal ALS protocol may be more appropriate in arrest management than using HOTT protocols?

Asphyxia

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Pelvic trauma

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Penetrating chest trauma

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Amputation

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Question 4 of 16

4. Question

You get called forward to scene after another one of your colleagues arrives in a rapid response car, your critical care team are also on route. As you pull up, police tell you the patient has been run over their abdomen area by a large SUV, CPR is ongoing by a police medic. You confirm arrest and look to implement your HOTT principles due to a potential major trauma cause.

The police medic has been doing chest compressions only for around 30-60 seconds. Should you ask the police medic to stop chest compressions and assist you while you carry out HOTT management procedures?

Yes

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No

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Question 5 of 16

5. Question

You stop chest compressions due to the possibility of exsanguination and for the extra support of the police officer. Should you follow the HOTT principles in order similar to your ABCD mnemonic or carry out your interventions simultaneously?

Simultaneously

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One after another

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Question 6 of 16

6. Question

You look to assign roles to get your interventions done as quick as possible. Your car colleague is on the airway, your crew mate applies a pelvic binder with the help of the police medic and you start stripping the chest for your bilateral chest decompression. You place your defibrillator on first and see a VF rhythm. What is your priority?

Shock the VF rhythm immediately

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Complete your HOTT protocol first then shock your VF rhythm

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Question 7 of 16

7. Question

You shock the patient then go to complete your bilateral chest decompression. At what landmark should these be placed initially?

Mid-clavicular line, 2nd intercostal space, just above the third rib

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Mid-clavicular line, 3rd intercostal space, just below the third rib

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Anterior-axillar line, 2nd intercostal space, just above the third rib

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Mid-axillar line, 4-5th intercostal space

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Question 8 of 16

8. Question

Your colleague on the airway has placed an i-gel successfully but is feeling resistance and inflations are unilateral. As you place your needle decompressions, you here a rush of air, a spluttering of blood, and inflations now improve. You feel you have covered the HOTT elements and look to start your CPR protocol, however, as you pull the patients coat from under them you notice a lot of blood. You carefully roll the patient slightly to look at their back and notice a stab wound just above the shoulder girdle on the left side oozing blood. What should you place on this wound?

Russell chest seal

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Pressure dressing

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Non-adherent bandages for wound compression

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Question 9 of 16

9. Question

You place your dressing, confirm no further haemorrhage, and continue with your ALS algorithm. Your latest rhythm check was PEA. Your airway is patent with good ETC02. The police medic continues CPR. You have worked very efficiently as a team and complete all your HOTT tasks quickly. What other factor should you consider however in this scenario?

You must now consider time-critical transfer to hospital for the injuries found

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You must continue with your ALS management on scene for at least 30 minutes

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You must contact your relevant critical care teams to ask for blood products so you can continue your ALS management on scene

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You must continue with your ALS management on scene for at least 30 minutes of asystole

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Question 10 of 16

10. Question

As extrication equipment is gathered, your crew mate is currently gaining access to start your ALS drugs which you start to get ready. What medications would you look to give?

Adrenaline

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TXA

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Fluid challenge

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Amiodarone

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Question 11 of 16

11. Question

You get in contact with your critical care team for an update on their arrival time. They are 20 minutes away from you. It would take you 12 minutes to get to your nearest Major trauma unit in the opposite direction. What do you do?

Transport to hospital in time-critical fashion as safe as possible

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Remain on scene as conducting ALS in a moving vehicle can be risky to colleagues

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Question 12 of 16

12. Question

Approximately what percentage of traumatic arrests will show an initial shockable rhythm?

7%

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1-2%

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20%

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33%

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Question 13 of 16

13. Question

If ROSC is achieved in penetrating chest trauma, what systolic blood pressure should we aim for?

80 mmHg

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90 mmHg

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100 mmHg

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110 mmHg

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Question 14 of 16

14. Question

After an incident such as this which is complex and multi-factorial, a structured debrief ideally should be completed after the incident which can aid in the lessons learnt, good points to highlight, and identify any psychological/well-being needs?

True

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False

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Question 15 of 16

15. Question

What are some of the symptoms of traumatic stress syndrome that you should highlight if seen in any colleagues?

Sleeplessness

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Flashbacks

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Anxious symptoms

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Irritability

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Difficulty concentrating

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Question 16 of 16

16. Question

You can ROLE a penetrating chest trauma in cardiac arrest if HOTT principles have been completed and 30 minutes of asystole have been recorded?

False

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True

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Traumatic Arrest Scenario

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