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Transport critically ill

  1. 1. TRANSPORT OF CRITICALLY ILL
  2. 2. WHO WHAT WHERE WHEN WHY SAFETY..SAFETY..SAFETY..
  3. 3. LEARNING OBJECTIVES • PHYSIOLOGICAL IMPACTS OF TRANSPORTATION • TYPES OF TRANSFER • ADVERSE EVENTS DURING TRANSPORTATION • ORGANIZATION OF TRANSFER • PREVENTION OF COMPLICATIONS
  4. 4. Dangers of transfers 1) Physiological changes: Resp: -decrease oxygenation -Increase incidence of VAP 24% in transported pt vs 4.4% in non transported pt Haemodynamics : Changes in HR, BP esp in post op pt Neuro : increase ICP
  5. 5. )Hostile and unfamiliar environment )Limited resources )Equipment problems )Technical complications )Failure of continuity of care )Crisis - e.g : hypotension/ hypertension/ arrythmias/ desatur
  6. 6. FREQUENCY AND NATURE OF UNEXPECTED EVENTS
  7. 7. types of transfer • Pre hospital • Inter-hospital • Intra-hospital
  8. 8. intrahospital transfer • From emergency to wards • From emergency to OT/ ICU • From ward to OT/ICU • From ward/ ICU to Radiology • From ward / ICU to ward/ ICU
  9. 9. ORGANIZATION OF TRANSFER cedures or tests outside the ICU is potentially hazardous, the
  10. 10. Guidelines for the inter- and intra-hospital transport of critically ill patients Critical Care Medicine Volume 32(1), January 2004, pp 256-262
  11. 11. Assessment Control Communication Evaluation Prepare and package Transport Remember acronym…..
  12. 12. Assessment • Initial assessment of the patient and situation as a whole • Indications - benefits must outweigh risks • Stabilize before transport • Anticipation of problem likely encountered en route • Degree of urgency to transfer
  13. 13. Stable to transfer?? • Refractory / Severe shock - High vasopressor/ inotrope - • Hypoxemia - High ventilator settings/ FiO2 1.0 ? • Secure airway when in doubt, borderline indication -> intubation
  14. 14. control and communicate • Communication - excellent communication within team and receiving end • Continuous assessment of effectiveness of resuscitation and stabilisation process
  15. 15. • Experienced staff in intensive care or transfer • Clear chain of responsibility
  16. 16. Prepare and package • Preparation of patient, equipment, supplies, accompanying medical and nursing personnel • Sufficient supplies of drugs, fluids and oxygen must be available to cope with extraordinary delays • Secure tubes, lines
  17. 17. equipments * Equipment for airway management: * -sized appropriately for each patient * -oxygen source of ample supply to provide for projected needs plus a 30-min reserve. * Adequate battery back up
  18. 18. References
  19. 19. *Basic resuscitation drugs, including epinephrine and anti-arrhythmic agents, are transported with each patient in the event of sudden cardiac arrest or arrhythmia. *Supplemental medications, such as sedatives and narcotic analgesics, are considered in each specific case.
  20. 20. TRANSPORT
  21. 21. accompanying personal * It is strongly recommended that a minimum of two people accompany a critically ill patient. * It is strongly recommended that a physician with training in airway management and ACLS, and critical care training or equivalent, accompany unstable patients.
  22. 22. * Continuous BP monitor, pulse oximeter, and cardiac monitor must accompany every patient without exception. * Alarms should be visible as well as audible in view of extraneous noise levels monitoring
  23. 23. documentation • Clinical status before, during and after transfer • patient condition - trend • medicolegal implications • proper handover referring -> transfer -> receiving doctor • in the end, evaluate process of transfer - for quality improvement
  24. 24. Prevention of complications • the necessity and safety for transport should be assessed by multidisciplinary team • risk of transport should be weighed against potential benefits • Use appropriate equipment, personal and planning for each transport can minimise these complications and ensure optimal benefit to patients
  25. 25. • Risks can be diminished if patients are appropriately selected and carefully monitored during transportation • In some cases, hazards of transporting a patient could be prevented by performing diagnostic or therapeutic procedures within ICU or choosing alternative procedures that may render a transport of the patient unnecessary.
  26. 26. • Avoid delay. Each 30 min delay can increase mortality 300 times in severe injured patient.
  27. 27. TERIMA KASIH •TERIMA KASIH

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