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Transportation of The Critically Ill Patient

Equipment Accompanying Personnel Preparation for Transport Monitoring During Transport Management During Transport Documentation Supplementary Equipment For Use During Transport Is The Patient Stable For Transport?

Equipment

As much of the equipment as possible should be mounted at or below the level of the patient . In particular, large arrays of vertical drip stands should be avoided. This allows unhindered access to the patient and improves stability of the patients bed. Ideally all equipment within a transport should be standardized to enable the seamless transfer of patients without, for example, interruption of drug therapy or monitoring due to incompatibility of leads and transducers.

All equipment should be robust, durable and lightweight. Electrical equipment must be designed to function on battery when not plugged into the mains. Portable monitors should have a clear illuminated display and be capable of displaying EKG, arterial oxygen saturation, non-invasive and invasive blood pressure monitoring, capnography and temperature. Alarms should be visible as well as audible.

Additional equipment for maintaining and securing the airway, IV access, etc should also be available

Accompanying Personnel

The critically ill patient should be accompanied by a minimum of two attendants. One attendant should be a medical practitioner with appropriate training in intensive care medicine, anesthesia, or other acute specialty. He or she should be competent in resuscitation, airway care, ventilation and other organ support. The responsible medical practitioner should be accompanied by another suitably experienced nurse, and or technician.

Preparation For Transport

Prior to departure, transport attendant must familiarize himself with treatment already undertaken and independently assess the patients condition. In all cases, full clinical details must be obtained, for example, (vent settings, all current meds, latest ABG, CBC, Metabolic panel, CXR) before leaving the unit or OR. Meticulous resuscitation and stabilization of the patient before transport is the key to avoiding complications during the journey.

The airway should be assessed and if necessary secured and protected. Intubated patients should normally be paralyzed and sedated. If a PTX is present or likely, chest drains should be inserted prior to departure. Secure venous access is mandatory and at least two wide bore IV cannulae are required. An arterial line is ideal for BP monitoring.

Hypovolemic patients tolerate moving poorly and circulating volume should be near normal prior to transport. This may require loading with crystalloid, colloid or blood. If inotropes or other vasoactive agents are required to optimize hemodynamic status, patients should be stabilized on these before leaving the unit. Patients who are persistently hypotensive despite resuscitation efforts should not be moved until stable. Continuing sources of blood loss or sepsis should be identified and controlled.

Monitoring During Transport

The standard of care and monitoring during transport should be at least as good as it is in the unit. Minimum standards required for all patients are appropriate staff, EKG, BP monitoring and arterial oxygen saturation. ICP monitoring may be required in certain patients. A written record of pt status, monitored values, treatment given and any other clinically relevant information should be completed after transfer.

Management During Transport

All equipment must be securely stowed. Under no circumstances should equipment (e.g. infusion pump) be left on top of the patient. Gas cylinders must properly be placed at the foot of the bed or if necessary, under the bed. Monitoring must be continuous throughout the transport. All monitors and pumps should be visible to accompanying staff. Adequately resuscitated and stabilized patients should not normally require dramatic changes to treatment during transport.

Documentation

Clear records must be maintained of all stages. These should include details of the patients condition prior to and after transport, details of vital signs, clinical events and therapy given during transport.

Supplementary Equipment

LMA ETTs Laryngoscopes Intubating stylet Tape for securing ETT Stethoscope Self inflating bag and mask with oxygen reservoir and tubing

Syringes Needles IV cannulae IV fluids Infusion sets/extensions

Is The Patient Stable For Transport

Airway

Ventilation

Airway safe or secured by intubation Tracheal tube position confirmed on CXR

Paralyzed, sedated and ventilated Adequate gas exchange confirmed by ABG

Circulation

Neurology

HR, BP stable Tissue and organ perfusion adequate Any obvious blood loss controlled Circulating blood volume restored Hb adequate Minimum of 2 routes of venous access

Seizures controlled, metabolic causes excluded Raised ICP appropriately managed

Trauma

C-spine protected PTX drained Long bonel/pelvic fractures stabilized Intra-thoracic and intra-abdominal bleeding controlled

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