83 Transportation of Critically Ill Patients |
673 |
|
|
Step 5: Monitoring during transport
This includes followings:
•ECG monitoring
•Pulse oximetry
•Periodic measurement of blood pressure, pulse rate, and respiratory rate
•Selective patients may benefits from capnography, continuous intra-arterial blood pressure monitoring, and intracranial pressure monitoring.
Step 6: Preparing intravenous access and airway before transport
•If peripheral venous access is unavailable, central venous access is established. If needed, fluid resuscitation and inotropic support are initiated, with all intravenous fluids and medications maintained in plastic (not glass) containers.
•A patient should not be transported before airway stabilization if it is judged likely that airway intervention will be needed en route (a process made more difficult in a moving vehicle).
•The airway must be evaluated before transport and secured. Finally, the patient’s medical record—laboratory and radiological data—is copied for the receiving unit.
•Use appropriate physical restraint.
•Particular attention has to be focused on the personnel, equipment, and monitoring in use to prevent adverse events during transportation of critically ill patients.
•Detailed planning of the process goes a long way in preventing the adverse events related to patient, equipment, and transport personnel.
Suggested Reading
1.Warren J, Fromm RE Jr., Orr RA, Rotello LC, Horst HM, American College of Critical Care Medicine. Guidelines for the inter and intra hospital transport of critically ill patients. Crit Care Med. 2004;32:256–62.
These guidelines promote measures to ensure safe patient transport during both intraand interhospital transport and give minimum standard regulations to ensure patient safety during transport by establishing an organized, efficient process supported by appropriate equipment and personnel.
2.Waydhas C. Intrahospital transfer of critically ill patients. Crit Care. 1999;3:R83–9.
This review addresses the type and incidence of adverse effects, risk factors and risk assessment, and the available information on efficiency and cost-effectiveness of transferring such patients for diagnostic or therapeutic interventions within hospital.