Transportation and Stabilitation in Critically Ill Patient - 2015
Transportation and Stabilitation in Critically Ill Patient - 2015
Stabilitation in
Critically Ill Patient
Intra - Hospital
• ICU
• Ward
• OT
• Radiology
• Etc..
Inter - Hospital
• Regional
• National
• International
CONTRA -
INDICATION INDICATION
•DIAGNOSTIC PURPOSES • POTENTIAL BENEFITS
e.g. CT SCAN , MRI. <POTENTIAL RISKS.
•THERAPEUTIC PURPOSE • UNSTABLE (OR) POTENTIALLY
e.g.:- SURGERY, PACEMAKER
UNSTABLE PATIENT .
•SPECIALIZED CARE e.g. :-
EMERGENCY DEPARTMENT TO
ICU (or) TERITIARY LEVEL
HOSPITAL.
Ground transport…
• Advantages of ground transport over air
transport
– Larger patient compartment
– Lower cost
– Relative immunity to changing weather
– Safer
– Less severe environmental factors
• Oxygen levels
• Acceleration/deceleration forces
• Gas volume changes with altitude
• Cabin pressurization
• Humidity
• Noise
• Vibration
Air Transport
• Advantages
– Faster
– Can accommodate more than one patient
– Allows care providers more room
• Increases workspace
• Holds more crew when patients require
• Disadvantages
– Requires large, sturdy landing site
• May be too heavy or large for some pads
– Expensive
• Original cost
• Maintenance
• Fuel
Ground Vs Air
• Communication.
• Personnel.
• Equipment.
• Monitoring.
• Handing over (Documents, Information).
• Medico legal and ethical aspects.
COMMUNICATION
PHYSICIAN TO NURSE TO
PHYSICIAN NURSE
INFORMATION
• Equipment needed.
Medication
Electronic devices
Trolley
Oxygen cylinder
Resuscitations Kit
Oxygen cylinder
Electronic Devices
Pulse Oxymeter
STANDARD RESUSCITATION
DRUGS
TROLLEY
PREPARING PATIENT FOR
TRANSPORT
• Secure intra venous access
• Airway stabilization
• Trauma victims – spinal mobilization
• Naso gastnc tube
• Foley’s catheterization
• Chest tube insertion
• All drains
• -under water seal
• -urinary
• -wound
• Infusion pump & IV drips functioning properly
• Soft wrist and leg restraints
• Vital signs displayed on monitors
• Patient is safely secured on a trolley
Trauma:Initial Stabilization
The Primary Survey
• Airway:
– Establish patency
– Beware C- Spine
– Do not:
• Flex
• Hyperextend
Trauma:Initial Stabilization
Suspected Airway Obstruction
• Stridor
• Cyanosis
• Absence of breath sounds
• Dysphagia, snoring, gurgling
• Altered mental status
• Trauma to head, face, neck
Trauma:Initial Stabilization
Airway Management
• Clear airway
• Jaw thrust/stabilization maneuver
• Oral/nasal airway
• Oxygenate/ventilate
• Intubation
• Cricothyroidotomy
Trauma:Initial Stabilization
C-Spine Immobilization
• Backboard
• Appropriate C-collar
• Snadbags or towel
• Tape
• Torso immobilization
Trauma:Initial Stabilization
Primary Survey: Breathing
• Assess via
– Exposure
– Rate/depth of respiration
– Inspection/palpation
– Quality/symmetry of breath
sounds
NB: An intact airway Does Not assure
adequate ventilation
Trauma:Initial Stabilization
Primary Survey: Breathing
• Oxygen
• Assisted ventilation
• Alleviate life threatening injuries
– Tension pneumothorax
– Hemothorax
– Flail chest
– Cardiac tamponade
Stabilitation
The patient with acute respiratory failure who
requires advanced mechanical ventilatory
support using :
– positive-end expiratory pressure (PEEP)
– pressure-controlled ventilatory modes
• Vascular access
– peripheral I.V.
• two large bore catheters
– intraosseous
– central venous line
– venous cutdown
Trauma:Initial Stabilization
Disability
• No convulsion
MONITORING
o Pulse
o Oxygen saturation
o BP,RR
IN-TRANSIT PROCEDURE
A best route
Continuous monitoring
ADVERSE EFFECTS OF
TRANSPORTATION
Hemodynamic instability
Hypertensive crisis
Systemic hypotension
Cardiac arrhythmias
Cardiac arrest
Airway obstruction
POTENTIAL MISHAPS
Accidental extubation.
Ventilator disconnects.
ECG disconnects.
Monitor power failure.
Vaso – active drug interruption.
Intravenous disconnection.
Stabilitation for transportation