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Transporting trauma patient (ACCEPT) (Prepare (Monitoring (Airway -…
Transporting trauma patient (ACCEPT)
Assessment - of the patient and the situation
Control - manage the transfer
Communicate
With receiving hospital
Formal handover (PS53)
Evaluate mode of transport
Road - useful if time is not critical and level of care in transit is more important than speed
Air (fixed wing vs helicopter)
Reduced 02 partial pressure
Need for pressurisation to sea level when clinically indicated
Gas expansion within patient and equipment (pneumothoracies, intraocular or intracranial air from open injuries, bowel obstruction, gas emboli, decompression sickness, ETT cuff)
Reduced temperature and humidity
Noise
Vibration
Factors determining mode
Distances involved
Urgency of the medical condition
Weather conditions
Availability of personnel and resources
Prepare
Patient
Stabilise (exception if stabilisation can only occur with treatment at receiving hospital e.g. internal haemorrhage)
Anticipate clinical needs
Giving appropriate doses of muscle relaxant or sedatives
Fresh bags of inotropes, IV fluids
Emptying drainage bags
Copy of clinical record
Monitoring
Airway - transport ventilator with high and low pressure alarms
Breathing - oximeter, capnography
Circulation - ECG, BP
Disability - GCS, pupils, pain
Extremities - pressure care, eye care
Others if indicated - temp, blood analysis, portable U/S
Alarms - should be audible and visual
Assistance - appropriate qualified nurse, orderly
Drugs - specific to patient's condition, basic resus drugs
Equipment
Needs to be appropriate for each transport
Duration
Patient illness and treatment
Size, weight, volume, battery life, 02 consump, durability
Sustainability for operation under conditions of transport
Must be restrained
Consider
Airway - 02, masks, airway adjuncts, intubation eqpt, suction
Breathing - ventilator (oxylog), self inflat bag (PEEP), Pleural drain eqpt (Helmlich valve - underwater seal not suitable)
Circulation - monitor, defib, external pacer, IV/ART lines, fluids, blood, pumps, syringes, needles, pericardiocentesis and thoracotomy eqpt
Package
Secure airway and IV access
Factors to consider regarding intubation prior to transfer
Risk of airway during transfer
Factors making intubation difficult
Stability
Liklihood of decompensation on induction in a location where assistance is harder to obtain
Appropriate monitoring - deays to get ideal monitoring may not be appropriate (AAA)