1 / 26

In Flight Patient Care Considerations for: Burns Neurological Spinal Cord

In Flight Patient Care Considerations for: Burns Neurological Spinal Cord. Objective.

kaloni
Download Presentation

In Flight Patient Care Considerations for: Burns Neurological Spinal Cord

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. In Flight Patient Care Considerations for: Burns Neurological Spinal Cord

  2. 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

  3. General Considerations • Preflight • Mode of transport • Patient Assessment • Supplies • Equipment

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. Neurological Injuries • Preflight Assessment • Diagnosis, treatment • Airway, Mechanical ventilation settings • LOC, GCS • Pupil assessment • Vital signs • Motor, sensory evaluation

  13. Neurological Injuries • Preflight Assessment • Diagnosis, treatment • Airway, Mechanical ventilation settings • LOC, GCS • Pupil assessment • Vital signs • Motor, sensory eval

  14. Neurological Injuries • Preflight Assessment • Seizure activity, medications • IVF, NG, Foley and patency

  15. Neurological Injuries • Stresses of flight • Decreased partial pressure of oxygen • Barometric Pressure Changes • Decreased Humidity • G-Forces

  16. 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

  17. 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

  18. 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

  19. ACCELERATION/DECELERATION FORCES POSITIONING THE LITTER PATIENT DURING TAKE-OFF/ LANDING

  20. Spinal Cord Injuries • Preflight Assessment • Diagnosis and treatment • Level of function • Airway secured, mech ventilation settings • Vital signs, POX, • Foley, NG • Medications

  21. Spinal Cord Injuries • Preflight Assessment • IVF and rate • Spinal cord immobilization – goal to preserve current level of function. Avoid logrolling patient • Spring loaded traction

  22. Spinal Cord Injuries • Stresses of flight • ALL!

  23. 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?

  24. 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

  25. ACCELERATION/DECELERATION FORCES POSITIONING THE LITTER PATIENT DURING TAKE-OFF/ LANDING

  26. Questions????

More Related