Page 105 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 11: Transportation of the Critically Ill Patient 73

TABLE 11-2 Preparing the Patient (Continued) TABLE 11-2 Preparing the Patient (Continued)
Portable suction Equipment
Rectal tube Thermometer
Absorbent pads Microbiology swabs/sample pots for long transfers
Metabolic/temperature Miscellaneous
Check Check
Temperature Long bone fracture stability—these should be splinted to provide pain relief and reduce
Electrolytes—potassium, calcium, and magnesium as IV salt solutions blood loss/tissue/neurovascular damage
Blood glucose Pressure areas
Insulin/glucose requirements Dressings
Metabolic acid-base balance Females: menstruation
Hemofiltration/dialysis requirements Allergies
Patient weight Patient comfort if awake
Monitoring Patient identity bracelet
Temperature probe/other measuring device Monitoring
Blood glucose monitor Skin, visual check of pressure areas, dressings
Point-of-care testing for long transfers Potential events
Potential events Development of pressure areas during transfer
Hypothermia Excessive soiling of dressings
Hyperthermia Drugs
Hypo/hyperglycemia Barrier cream
Electrolyte abnormalities Antihistamine, epinephrine, corticosteroid, intravenous fluid
Drugs Equipment
Electrolyte replacement Pressure relieving pads/mattress
Short-acting insulin Adhesive tape
Glucose—oral and intravenous Scissors
Diuretic Bandages, gauze, dressings, etc
Equipment Absorbent pads
Thermometer Pillow, blankets, ear plugs, food, and water for the patient as appropriate to optimize
Warming/insulating blanket comfort during long journeys
Cooling device Power inverter/generator
Point-of-care testing/blood glucose monitor
Hyperbaric equipment
and management of patient deterioration during transfer. The moni-
47
Immune/infection
toring used during transfer should have the same capabilities as that
Check used on the intensive care unit and, ideally, should be capable of data
Infective status of the patient—positive screens/cultures recording, although this does not obviate the requirement for written
documentation. Charts and results for the previous 12 hours should
20
Infection control procedures required be reviewed to assess patient stability and suitability for transfer.
Antimicrobials—current and recent The majority of adverse events during transfer have been attributed to
Antipyretic requirements equipment failure, thus all staff members should be familiar with, and
48
Temperature have thoroughly checked all equipment prior to departure. Adequate
battery supplies should be taken to ensure optimum operation for the
Inflammation blood profile entire duration of the journey plus spares for delays en route. The team
Wounds—change dressings if possible prior to transfer leader should brief the team on management of emergencies en route.
Monitoring The ability to perform procedures such as advanced life support can
be limited within a confined space, thus all team members should be
49
Temperature
made aware of their roles during such an event.
Potential events
Equipment: Standards for equipment provision are stipulated by
New onset pyrexia national guidelines. As a rule, the patient should receive the same
8,9
Contamination by infective agents level of monitoring they received prior to transfer. A number of
Drugs studies identify equipment-related adverse events, particularly in
Antipyretic relation to portable ventilators, invasive monitoring, and sedation.
All authors highlight inadequate knowledge as being contributory to
Broad spectrum antibiotic for long transfers such events. 10,40,53

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