In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.
-
Upload
reece-tremelling -
Category
Documents
-
view
217 -
download
0
Transcript of In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.
![Page 1: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/1.jpg)
In Flight Patient Care Considerations for:
BurnsNeurologicalSpinal Cord
![Page 2: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/2.jpg)
Objective
• Apply knowledge of flight physiology and aviation environmental stressors in the planning and delivery of pre-flight and in-flight care of patients with cardiopulmonary, gastrointestinal, genitourinary, neurological, ophthalmologic, otorhinolaryngologic, orthopedic, and burn injuries and conditions
![Page 3: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/3.jpg)
General Considerations
• Preflight Mode of transportPatient AssessmentSuppliesEquipment
![Page 4: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/4.jpg)
General Considerations
• IV flow rates without pump
• O2 conversion table – sea level equivalent
• Securing patient and equipment
• Securing self
• Reliance on low tech physical assessment
• Hearing protection for patient and ERC personnel
![Page 5: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/5.jpg)
Burn Injuries
• Preflight Assessment%TBSA burned, location and sourceStatus of airway and patencyVascular accessFluid requirementsPatency of foley, NGVital signs, POX, urine output
![Page 6: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/6.jpg)
Burn Injuries
• Preflight AssessmentPain medication, sedationPeripheral pulsesPresent wound managementAssociated injuries and need for altitude
restriction (CXR)Secure vascular access, ET tube with
sutures
![Page 7: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/7.jpg)
Burn Injuries
• Preflight AssessmentAssess Hct and transfuse if < 30% prior to
flightIf MD orders topical cream, apply evenly
1/16 to 1/8 inch thick and cover with absorbent dressing and Kling
![Page 8: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/8.jpg)
Burn Injuries
• Stresses of flightAll stresses of flight will affect the burn
victim Thermal Decreased partial pressure of oxygenDecreased barometric pressureDecreased humidity
![Page 9: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/9.jpg)
Burn Injuries
• In-flight considerationsMonitor mental statusAdminister warmed, humidified oxygen –
exception for face, head, neck burnsElevate headContinue with fluid resuscitation- second 24
hours add colloids – 200ml salt poor albumin/800ml LR at 0.5ml/kg/%TBSA
![Page 10: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/10.jpg)
Burn Injuries
• In-flight considerationsSecond 24 hours addition of dextrose to
meet metabolic demands – D51/4 NSMaintain urine output >50ml/hr(75-100ml
for electrical) monitor for myoglobinuriaNG to gravity or suction -monitorHourly evaluation of all peripheral pulses
![Page 11: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/11.jpg)
Burn Injuries
• In-flight considerationsProtect from convection heat losses – shield
from drafts and airflowMaintain core body temperature 99-100Dressings should be occlusive, NEVER
change en routeMedicate frequently – use small doses
Morphine 2-4 mg IVP. Avoid Demerol
![Page 12: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/12.jpg)
Neurological Injuries
• Preflight AssessmentDiagnosis, treatmentAirway, Mechanical ventilation settingsLOC, GCSPupil assessmentVital signsMotor, sensory evaluation
![Page 13: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/13.jpg)
Neurological Injuries
• Preflight AssessmentDiagnosis, treatmentAirway, Mechanical ventilation settingsLOC, GCSPupil assessmentVital signsMotor, sensory eval
![Page 14: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/14.jpg)
Neurological Injuries
• Preflight Assessment Seizure activity, medicationsIVF, NG, Foley and patency
![Page 15: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/15.jpg)
Neurological Injuries
• Stresses of flightDecreased partial pressure of oxygenBarometric Pressure ChangesDecreased HumidityG-Forces
![Page 16: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/16.jpg)
Neurological Injuries
• In-flight considerationsField-level altitude restriction for all
penetrating, PBI induced head injuriesMaintain POX>/=95%, tight ETCO2
control between 25-27(pCO2 30-32)Administer paralytics, sedation as neededAvoid succinylcholine use for RSI – IIP
![Page 17: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/17.jpg)
Neurological Injuries
• In-flight Considerations IVF in absence of causes of hypovolemia at 80ml
NS/hr – maintain MAP 65-70Closely monitor GCS, pupils –for deterioration in
GCS or pupil changes evidencing IIP administer 20% Mannitol 1-1.5 g/kg bolus
Maintain normothermic – protect from thermal changes
![Page 18: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/18.jpg)
Neurological Injuries
• In-flight ConsiderationsElevate headNG/OG to gravity/suctionMonitor for seizure activity – administer
Dilantin prophylaxis, Valium for seizuresHypertension – administer MetoprololHearing protection, eye protection
![Page 19: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/19.jpg)
ACCELERATION/DECELERATION FORCES
POSITIONING THE LITTER PATIENT
DURING TAKE-OFF/ LANDING
![Page 20: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/20.jpg)
Spinal Cord Injuries
• Preflight Assessment
• Diagnosis and treatment
• Level of function
• Airway secured, mech ventilation settings
• Vital signs, POX,
• Foley, NG
• Medications
![Page 21: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/21.jpg)
Spinal Cord Injuries
• Preflight AssessmentIVF and rateSpinal cord immobilization – goal to
preserve current level of function. Avoid logrolling patient
Spring loaded traction
![Page 22: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/22.jpg)
Spinal Cord Injuries
• Stresses of flightALL!
![Page 23: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/23.jpg)
Spinal Cord Injuries
• In-flight ConsiderationMaintain spinal immobilizationMaintain POX 95% or >, EtCO2 30-40
unless concomitant head injury then 25-27Altitude restriction if associated head injuryIVF 80ml/hr NSMonitor vital signs – Neosynephrine for
neurogenic shock? Dopamine?
![Page 24: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/24.jpg)
Spinal Cord Injuries
• In-flight ConsiderationMaintain Methylprednisolone drip if in
progressProtect from hypothermiaProtect from G forces-loss of vasomotor
tone in spinal shock
![Page 25: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/25.jpg)
ACCELERATION/DECELERATION FORCES
POSITIONING THE LITTER PATIENT
DURING TAKE-OFF/ LANDING
![Page 26: In Flight Patient Care Considerations for: Burns Neurological Spinal Cord.](https://reader034.fdocuments.in/reader034/viewer/2022051517/56649c9b5503460f94959344/html5/thumbnails/26.jpg)
Questions????