Rob recounts the story of his first traumatic cardiac arrest as a paramedic. 

•  CPR doesn't make sense in a traumatic arrest where hemorrhagic and obstructive shock are the suspected etiology
• A 'three hole punch' are bilateral finger thoracostomies and a pericardialcentesis is one way to decompress the chest in blunt traumatic cardiac arrest
• The nurse's role is to ensure a shared mental model once the patient arrives so that CPR is started and/or stopped

Evidence

• PMID 29177620
• https://resus.org.au/download/section_11/anzcor-guideline-11-10-1-als-traumatic-arrest-27apr16.pdf&ved=2ahUKEwiczvjHitnkAhXFvJ4KHSvNCfEQFjALegQIARAB&usg=AOvVaw2ztgUJeIvyARaNjrCTrBRv