How to Perform CPR for Trauma Patients: A Step-by-Step Guide

Performing CPR on trauma patients presents unique challenges. Trauma, often linked to severe accidents or injuries, complicates life-saving efforts due to factors like internal bleeding or spinal damage. In this guide, we’ll outline the critical steps and special considerations for effectively performing CPR on trauma patients, ensuring your actions do not worsen their injuries.

What is Trauma?

Trauma is any serious injury or damage to the body caused by an external force, like an accident, fall, or violent impact. It involves anything from broken bones and deep cuts to more severe issues like internal bleeding or damage to vital organs. Trauma happens from things like car crashes, sports injuries, or violent attacks. In most cases, immediate medical help is essential to assess the severity of the injury and provide the necessary treatment to prevent complications or long-term damage.

When to Perform CPR on Trauma Patients?

Perform CPR on trauma patients when they are unresponsive, not breathing, and have no pulse. Immediate CPR is necessary to increase survival chances but be cautious of potential hazards at the scene.

Additionally, if the patient has severe trauma (blood loss, respiratory failure, or chest injuries), cardiac arrest occur, making CPR crucial to prevent further complications.

Key Differences Between Standard CPR and Trauma CPR

Unlike standard CPR, trauma CPR requires extra care to avoid aggravating spinal injuries. Maintaining proper head stabilization and minimizing neck movement during compressions are crucial to avoid worsening spinal trauma.

• Spinal Injuries: In trauma CPR, there’s a higher risk of spinal injuries. Special care is needed to stabilize the head and neck, minimizing movement during chest compressions and airway management to prevent further damage.
• Control of Bleeding: Trauma patients often have severe bleeding. Before starting CPR, control external bleeding with direct pressure if possible. Internal bleeding complicates CPR, but it should still be performed if the patient is in cardiac arrest.
• Airway Management: For trauma patients, use the jaw-thrust maneuver to open the airway, instead of the head-tilt-chin-lift method, to avoid worsening a potential spinal injury.

How to Perform CPR on Trauma Patients?

Performing CPR on trauma patients requires specific techniques to avoid exacerbating their injuries while providing life-saving care. Trauma patients often suffer from injuries such as spinal damage, internal bleeding, and fractures, which complicate the standard CPR process. Here’s a step by step CPR for trauma patients:

1. Ensure Scene Safety: Assess the environment for hazards before approaching the trauma patient. Only approach if it’s safe; otherwise, wait for professional help. Check the patient for responsiveness and look for life-threatening injuries like heavy bleeding or fractures.
2. Check for Signs of Life: If the patient is unresponsive, check for breathing and pulse for no more than 10 seconds. Severe blood loss or airway obstruction causes cardiac arrest, but start CPR immediately if there’s no breathing or pulse.
3. Begin Chest Compressions: Place your hands on the center of the chest and perform compressions at a rate of 100–120 per minute to a depth of 2 inches (5 cm). Minimize head or neck movement if a spinal injury is suspected, even during compressions.
4. Control Severe External Bleeding: If there’s bleeding, apply direct pressure to the wound before or during CPR. Consider using a tourniquet for limb injuries as a last resort.
5. Administer Rescue Breaths: After every 30 compressions, give 2 rescue breaths using the jaw-thrust maneuver if spinal trauma is suspected. Use a barrier device if available to aid in ventilation.
6. Monitor for Signs of Recovery: Continuously observe the patient for any signs of recovery, such as breathing or movement. Continue CPR until EMS arrives or the patient shows signs of life.
7. Prepare for Potential Complications: Be aware that rib fractures and spinal injuries occur. Continue CPR despite possible further damage while stabilizing the patient’s head and neck to avoid aggravating spinal injuries.

1. Ensure Scene Safety and Assess the Situation

Before approaching a trauma patient, assess the surroundings to ensure it's safe to proceed. Trauma occurs in hazardous situations like car crashes, falls from heights, or areas with ongoing danger. Only approach the patient if it’s safe to do so. If not, wait for professional help.

Approach the patient and check for responsiveness by shouting and tapping their shoulder. Simultaneously, assess the environment for any life-threatening injuries like heavy bleeding, visible fractures, or penetrating injuries.

2. Check for Signs of Life

Check for breathing and a pulse for no more than 10 seconds if the patient is unresponsive. In some cases, trauma patients go into cardiac arrest due to severe blood loss (hypovolemic shock), direct trauma to the heart, or respiratory failure.

• Severe Blood Loss: Blood loss leads to cardiac arrest, but it's important not to delay CPR even if bleeding is evident.
• Obstructed Airway: In cases of facial trauma or chest injuries, airway obstruction is the cause of the arrest. If possible, check the mouth and airway for obstructions, but prioritize CPR if there is no breathing or pulse.

3. Begin Chest Compressions

Place the heel of your hand on the center of the patient’s chest, on the lower half of the sternum (breastbone). Place your other hand on top, interlacing the fingers. For trauma patients with rib fractures or chest injuries, avoid unnecessary movement of the chest wall.

• Perform chest compressions at a rate of 100–120 compressions per minute.
• Compress the chest to a depth of 2-2.4 inches (5-6 cm) for adults, 2 inches (5cm) for children, and 1.5 inches deep (4cm) for infants
• Allow the chest to fully recoil between compressions to ensure proper blood flow. Trauma patients have broken ribs or chest trauma, but compressions should continue, as oxygen flow to vital organs is critical.

Take special care not to move the patient’s head or neck while performing compressions if a spinal injury is suspected. Even slight movement causes further damage, especially with cervical spine injuries.

4. Control Severe External Bleeding 

If the trauma patient has external bleeding (from a gunshot wound or car accident), prioritize controlling the bleeding before or while performing CPR. Apply direct pressure to the wound using a cloth, gauze, or your hands. If bleeding is from a limb, consider using a tourniquet as a last resort to prevent further blood loss.

5. Administer Rescue Breaths

After every 30 compressions, give 2 rescue breaths. Use the jaw-thrust maneuver instead of the traditional head-tilt-chin-lift if spinal trauma is suspected. Place your fingers behind the angles of the patient’s lower jaw and lift forward. This opens the airway without moving the head or neck, minimizing the risk of spinal injury.

• If the patient has facial trauma or airway injuries, be cautious while giving rescue breaths. Ensure the airway is open and clear.
• Use a barrier device, like a pocket mask or bag-valve-mask, if available, especially when facial injuries are present. This prevents direct contact and aids in effective ventilation.

6. Monitor for Signs of Recovery

While performing CPR, monitor closely for any signs of recovery, such as spontaneous breathing, movement, or coughing. Continue CPR until emergency medical services (EMS) arrive or the patient begins to show signs of life. Trauma patients take longer to respond due to internal injuries or severe blood loss.

7. Prepare for Potential Complications

In trauma patients, rib fractures or sternum injuries are common due to the impact of the accident. While chest compressions cause further rib damage, CPR is essential to sustain life, and compressions should continue despite the injury.

Spinal cord injuries paralyze or kill if aggravated, so minimizing movement is crucial. Throughout the CPR process, try to stabilize the patient’s head and neck without turning or twisting them, especially if you suspect cervical spine damage.

Additional Tips for Trauma CPR

• Spinal Immobilization Tools: If available, a backboard and cervical collar help stabilize the patient's spine while CPR is being performed. This reduces the risk of spinal cord damage.
• Tourniquets for Bleeding Control: In extreme cases where external bleeding is uncontrollable, a tourniquet is applied to limbs to prevent further blood loss. However, this should only be used when necessary, as improper use causes further damage.
• Advanced Airway Management: In hospital or advanced trauma settings, airway management tools (such as intubation) are used to secure the airway in patients with facial trauma or spinal injuries. Field responders will often carry this equipment.

These steps provide life-saving CPR while minimizing additional harm in trauma patients, considering their specific injuries and the complications associated with traumatic injuries.

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When to Stop CPR?

Only stop CPR when professional help arrives and takes over, or if the patient shows clear signs of recovery, such as regaining consciousness or breathing on their own. If EMS declares the patient deceased, CPR efforts should cease. In cases where CPR has been performed for an extended period without success, and advanced care is not available, a healthcare professional will make the final decision.

Can you perform CPR on someone with a suspected spinal injury?

Yes, but extra caution is required. Use the jaw-thrust maneuver to open the airway, avoiding unnecessary neck movement during chest compressions.

Should you stabilize a trauma victim before starting CPR?

Yes, you should stabilize a trauma victim before starting CPR. While immediate CPR is crucial, stabilizing life-threatening injuries takes precedence. The American Heart Association (AHA) emphasizes that high-quality CPR should begin without delay, but it includes steps to address critical conditions if they are managed quickly.

What should you do if a trauma patient has severe bleeding?

If a trauma patient has severe bleeding, apply direct pressure to control external bleeding if possible before starting CPR. In cases of internal bleeding, continue CPR but monitor the patient closely for any worsening of their condition.

Are there special tools or equipment needed for trauma CPR?

In some cases, trauma-specific CPR benefits from tools like backboards for spinal stabilization, cervical collars, or tourniquets for hemorrhage control. However, basic CPR should not be delayed if these tools are unavailable.

Are there any specific challenges when performing CPR on trauma victims with collapsed lungs?

Yes, trauma patients with collapsed lungs (pneumothorax) face compromised respiratory function, which CPR exacerbates, leading to further complications. A study found that patients with tension pneumothorax had a 50% mortality rate if not treated promptly, highlighting the importance of addressing this issue. In such cases, immediate needle decompression relieves pressure before CPR is administered.

What are the ethical considerations for performing CPR on trauma patients with severe injuries?

The ethical considerations of performing CPR on trauma patients with severe injuries include assessing the potential quality of life post-resuscitation, respecting the patient’s or family's wishes regarding aggressive interventions, evaluating the futility of care if the chances of survival are minimal, and considering the allocation of healthcare resources in critical situations.

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What is the survival rate of trauma patients who receive CPR?

Research indicates that survival rates for trauma patients receiving CPR vary significantly. For example, a study published in the Journal of Trauma found that only about 2-3% of patients with blunt trauma who required CPR survived to discharge. Conversely, those with penetrating trauma (stab wounds or gunshot wounds) had higher survival rates, ranging from 10% to 30%.

Key factors affecting survival include the promptness of CPR initiation, the cause of the trauma, and the patient’s overall health before the injury.

What post-CPR care is needed for trauma victims who survive resuscitation?

Post-resuscitation care for trauma patients who survive resuscitation often include:

• Continuous monitoring of vital signs.
• Assessment for potential complications such as acute respiratory distress syndrome (ARDS).
• Implementation of therapeutic hypothermia if indicated, to protect brain function.

Research indicates that about 30-50% of trauma patients who survive CPR experience neurological impairments, emphasizing the need for comprehensive follow-up care.

How does CPR training improve survival rates in trauma emergencies?

CPR training improves survival rates in trauma emergencies by providing individuals with the skills needed to deliver immediate, effective care during critical moments. High-quality chest compressions maintain blood circulation to vital organs, increasing the likelihood of survival until advanced medical help arrives. Trauma victims receiving prompt CPR experience significantly higher survival rates compared to those without intervention. Trained individuals are better prepared to manage life-threatening situations, including airway obstruction or severe bleeding, alongside performing CPR, which enhances overall patient outcomes.

Do bystanders with CPR training make a difference in trauma situations?

Bystanders with CPR training make a significant difference in trauma situations by delivering life-saving care before professional help arrives. Trained individuals recognize when CPR is necessary and take immediate action, maintaining circulation and oxygen flow to the brain. Online CPR and First Aid Certification courses, such as those from CPR Select, equip people with these essential skills conveniently, enabling them to act confidently in emergencies. Bystander intervention increases trauma survival rates, particularly in situations where emergency services face delays in reaching the victim.

Sources:

• Peberdy, M. A., Kaye, W., Ornato, J. P., et al. (2003). "Cardiopulmonary Resuscitation of Trauma Patients." Resuscitation, 58(3): 297-307.
• Kuhls, D. A., et al. (2007). "Ethical Considerations in Trauma Resuscitation." Journal of Trauma Nursing, 14(4): 222-228
• Morrison, L. J., Verbeek, P. R., Zhan, C., Kiss, A., & Allan, K. S. (2009). "Validation of the Use of the Term ‘Futility’ in CPR for Trauma Patients." Resuscitation, 80(6): 679-684.
• Macintosh, K., R. Horst, et al. (2013). "Outcomes of Trauma Patients Who Undergo Cardiopulmonary Resuscitation." Journal of Trauma and Acute Care Surgery, 74(3): 1044-1050.
• American Heart Association. (2020). "CPR Guidelines for Trauma Patients." American Heart Association Guidelines Update for CPR and Emergency Cardiovascular Care.
• American Red Cross. (2022). "CPR and First Aid Guidelines for Trauma Patients." American Red Cross First Aid/CPR/AED Manual.

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