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Presentation Transcript

In Flight Patient Care

Considerations for:

Burns

Neurological

Spinal Cord


Objective
Objective

  • Apply knowledge of flight physiology and aviation environmental stressors in the planning and delivery of pre-flight and in-flight care of patients with cardiopulmonary, gastrointestinal, genitourinary, neurological, ophthalmologic, otorhinolaryngologic, orthopedic, and burn injuries and conditions


General considerations
General Considerations

  • Preflight

  • Mode of transport

  • Patient Assessment

  • Supplies

  • Equipment


General considerations1
General Considerations

  • IV flow rates without pump

  • O2 conversion table – sea level equivalent

  • Securing patient and equipment

  • Securing self

  • Reliance on low tech physical assessment

  • Hearing protection for patient and ERC personnel


Burn injuries
Burn Injuries

  • Preflight Assessment

  • %TBSA burned, location and source

  • Status of airway and patency

  • Vascular access

  • Fluid requirements

  • Patency of foley, NG

  • Vital signs, POX, urine output


Burn injuries1
Burn Injuries

  • Preflight Assessment

  • Pain medication, sedation

  • Peripheral pulses

  • Present wound management

  • Associated injuries and need for altitude restriction (CXR)

  • Secure vascular access, ET tube with sutures


Burn injuries2
Burn Injuries

  • Preflight Assessment

  • Assess Hct and transfuse if < 30% prior to flight

  • If MD orders topical cream, apply evenly 1/16 to 1/8 inch thick and cover with absorbent dressing and Kling


Burn injuries3
Burn Injuries

  • Stresses of flight

  • All stresses of flight will affect the burn victim

  • Thermal

  • Decreased partial pressure of oxygen

  • Decreased barometric pressure

  • Decreased humidity


Burn injuries4
Burn Injuries

  • In-flight considerations

  • Monitor mental status

  • Administer warmed, humidified oxygen – exception for face, head, neck burns

  • Elevate head

  • Continue with fluid resuscitation- second 24 hours add colloids – 200ml salt poor albumin/800ml LR at 0.5ml/kg/%TBSA


Burn injuries5
Burn Injuries

  • In-flight considerations

  • Second 24 hours addition of dextrose to meet metabolic demands – D51/4 NS

  • Maintain urine output >50ml/hr(75-100ml for electrical) monitor for myoglobinuria

  • NG to gravity or suction -monitor

  • Hourly evaluation of all peripheral pulses


Burn injuries6
Burn Injuries

  • In-flight considerations

  • Protect from convection heat losses – shield from drafts and airflow

  • Maintain core body temperature 99-100

  • Dressings should be occlusive, NEVER change en route

  • Medicate frequently – use small doses Morphine 2-4 mg IVP. Avoid Demerol


Neurological injuries
Neurological Injuries

  • Preflight Assessment

  • Diagnosis, treatment

  • Airway, Mechanical ventilation settings

  • LOC, GCS

  • Pupil assessment

  • Vital signs

  • Motor, sensory evaluation


Neurological injuries1
Neurological Injuries

  • Preflight Assessment

  • Diagnosis, treatment

  • Airway, Mechanical ventilation settings

  • LOC, GCS

  • Pupil assessment

  • Vital signs

  • Motor, sensory eval


Neurological injuries2
Neurological Injuries

  • Preflight Assessment

  • Seizure activity, medications

  • IVF, NG, Foley and patency


Neurological injuries3
Neurological Injuries

  • Stresses of flight

  • Decreased partial pressure of oxygen

  • Barometric Pressure Changes

  • Decreased Humidity

  • G-Forces


Neurological injuries4
Neurological Injuries

  • In-flight considerations

  • Field-level altitude restriction for all penetrating, PBI induced head injuries

  • Maintain POX>/=95%, tight ETCO2 control between 25-27(pCO2 30-32)

  • Administer paralytics, sedation as needed

  • Avoid succinylcholine use for RSI – IIP


Neurological injuries5
Neurological Injuries

  • In-flight Considerations

  • IVF in absence of causes of hypovolemia at 80ml NS/hr – maintain MAP 65-70

  • Closely monitor GCS, pupils –for deterioration in GCS or pupil changes evidencing IIP administer 20% Mannitol 1-1.5 g/kg bolus

  • Maintain normothermic – protect from thermal changes


Neurological injuries6
Neurological Injuries

  • In-flight Considerations

  • Elevate head

  • NG/OG to gravity/suction

  • Monitor for seizure activity – administer Dilantin prophylaxis, Valium for seizures

  • Hypertension – administer Metoprolol

  • Hearing protection, eye protection


Acceleration deceleration forces
ACCELERATION/DECELERATION FORCES

POSITIONING THE LITTER PATIENT

DURING TAKE-OFF/ LANDING


Spinal cord injuries
Spinal Cord Injuries

  • Preflight Assessment

  • Diagnosis and treatment

  • Level of function

  • Airway secured, mech ventilation settings

  • Vital signs, POX,

  • Foley, NG

  • Medications


Spinal cord injuries1
Spinal Cord Injuries

  • Preflight Assessment

  • IVF and rate

  • Spinal cord immobilization – goal to preserve current level of function. Avoid logrolling patient

  • Spring loaded traction


Spinal cord injuries2
Spinal Cord Injuries

  • Stresses of flight

  • ALL!


Spinal cord injuries3
Spinal Cord Injuries

  • In-flight Consideration

  • Maintain spinal immobilization

  • Maintain POX 95% or >, EtCO2 30-40 unless concomitant head injury then 25-27

  • Altitude restriction if associated head injury

  • IVF 80ml/hr NS

  • Monitor vital signs – Neosynephrine for neurogenic shock? Dopamine?


Spinal cord injuries4
Spinal Cord Injuries

  • In-flight Consideration

  • Maintain Methylprednisolone drip if in progress

  • Protect from hypothermia

  • Protect from G forces-loss of vasomotor tone in spinal shock


Acceleration deceleration forces1
ACCELERATION/DECELERATION FORCES

POSITIONING THE LITTER PATIENT

DURING TAKE-OFF/ LANDING



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