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In Flight Patient Care Considerations for: Burns Neurological Spinal Cord

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Presentation Transcript
slide1
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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