CICM SAQ 2010.2 Q7

Questions

Briefly discuss the problems specific to aeromedical transport of a critically ill patient.

Answers

Answer and interpretation

Briefly discuss the problems specific to aeromedical transport of a critically ill patient.

  • Transport by any means involves risk to staff and patients
  • Need to be familiar with the use of the transport vehicle’s O2, suction, communications,and other equipment systems.
  • Reduction in partial pressure of oxygen with altitude, critically ill patients who are already dependent on high FiO2 may be further compromised.
  • Expansion of trapped gases – pneumothoraces, intracranial air from injuries Expansion of air containing equipment – ET tube, Sengstaken tube. ET cuff pressures will need to be adjusted
  • IABP difficult to transport
  • Risk of hypothermia
  • As water partial pressure falls, risk of dehydration through resp losses and passive humidification important
  • Auscultation is difficult.
  • The ventilated patient is placed in the Trendelenburg and the reverse Trendelenburg positions during take off and landing respectively. This can impact on perfusion and oxygenation.
  • Potential for pacemaker malfunction due to avionic interference.
  • Staff doing air transport should refrain from compressed gas diving for at least 24 hrs prior to transfer.
  • Physical problems: cold, noise, lighting, access to patient, motion sickness, acceleration injuries (eg head to front of plane to avoid increased ICP on takeoff)
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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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