6/6/2018. Pediatric Critical Care Transport. Objectives. Sonea Qureshi MD, CMTE Loma Linda University Children s Hospital
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1 Pediatric Critical Care Transport Sonea Qureshi MD, CMTE Loma Linda University Children s Hospital Objectives» Review the basic principles of transport» Overview of our transport process» Non-Technical skills during transport 1
2 Introduction» Pediatric intensive care unit decreased morbidity/mortality for many devastating pediatric illnesses» PICU regionalization/patient distance often warrant need for transport» Initial stabilization followed by appropriate transport lowered morbidity/mortality»reduction in acute physiology disturbances and a reduced mortality in critically ill patients transferred by a specialized retrieval team»137 transports performed by referral specialist (mainly pediatrician)»112 transports performed by pediatric intensivist team»transfers performed by the referral physicians were associated with a higher incidence of complications, unviability of equipment and more frequent requirements for acute intervention 2
3 Pediatric Critical Care Transport Team»Established in 1989»Two transport teams ~ Resident physician, transport nurse, transport respiratory therapist»ground ambulance, helicopter, fixed wing» pediatric transports per year»dispatch team within 30 minutes of initial call Goal»To provide safe, state of the art pediatric medical care while in transit»extension of pediatric intensive therapy to referring hospital via direct communication and the transport team»early resuscitation ABC s, cerebral protection and use of Evidence based medicine Indications for Emergency Transport of Pediatric Patients (Johnson & Gonyea, Mayo Clin Proc, 1993; 68: )» Respiratory--30%» Neurologic--22%» Trauma ~ Head--7% ~ Other--11%» Cardiovascular--6%» Other--24% 3
4 Transport Process ~ A call comes in from another hospital ~ The administrative assistant will take the call and fill out part of an information sheet (green sheet) ~ The PICU attending/fellow will talk to the MD at the facility and gather more information determine the patient s status ~ Availability of beds is considered with the Charge Nurse and patient placement ~ The patient is accepted and the transport team is activated 4
5 Pediatric Transport Team Composition Physician - Pediatric resident /fellow PICU Nurse PICU Respiratory Therapist Ambulance driver/helicopter pilot EMT Skills Cognitive Procedural Non-technical skills Pre transport Information»Referring physician, hospital, city, telephone number»patient name, age, weight»prehospital history»clinical status at presentation, current»interventions performed»current medications»current problem list»allergies 5
6 Pediatric Transport Equipment» Comprehensive/compatible» Self-sufficient» Last duration of transport» Battery powered» Compact, light» Minimal movement artifact 6
7 Pediatric Transport Equipment»BP cuffs»suction catheters»infant/adult electrodes»lancets»cotton balls»band-aids»surgilube»alcohol wipes»betadine swabs»crystalline temps»syringes»tubing»feeding tubes»foley catheters»sterile gloves»needles»tape»iv s»arm boards»tourniquets»intraosseous needles»bulb syringe»gauze»minor surgical instruments 7
8 Pediatric Transport Medications»Adenosine»Albumin»Amiodarone»Ampicillin»Ativan»Atropine»Benadryl»Calcium»Cefotaxime»Decadron»Dextrose»Dilantin»Dopamine»Epinephrine»Isuprel»Lasix»Lidocaine»Mannitol»Milrinone»Morphine»Sodium bicarbonate»nafcillin»nipride»norcuron Pentothal Phenobarbital Prostin Solumedrol Versed Crystalloid 3% saline Chemstrips Medication Bag Nursing Supplies 8
9 Respiratory Supplies Common complications 9
10 Anesthetists Non-Technical Skills Non-technical skills in the intensive care unit T.Reader, R. Flin, K. Lauchr British Journal of Anesthesiology 96 (5):551-9 (2006) Question» Following elements are essential in a safe and efficient pediatric critical care transport» A) Training and skill» B) Initial resuscitation at the referring hospital» C) Effective communication between the teams» D) Specialized equipment» E) All of the above 10
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