TRANSPORT OF CRITICALLY ILL

PATIENTDr vipul thakkar

Consultant – critical care

Cims hospital , ahmedabad

TRANSPORT OF MECHANICALLY VENTILAATED PT Transport monitor, Airway- expert, transport ventilator Check ET Position, FIX, suction, confirm

receiveing facility

Special need- PEEP, MODE of ventilation

ASK YOURSELF- IS PT. IS SHIFTABLE ? High vasopressors – refractory shock ?

High FiO2, High oxygen requirement..

? Benefits of transfer vs. risk during ……?

TRANSFER – SHOULD “ mobile but seamless continuation of ICU environment”

IN HOSPITAL TRANSFER Checklist for MAN, MACHINE, drugs

Prior communication with team members and destination team

Assess route-time of transfer

Document the process , events.

WHO should accompany pt.? What equipment, monitors needed ? Adequacy of equipment - Amount, size,

functional status

PERSONNEL Doctor, nurse, assistant Clear chain of responsibility Proper hand over referring transfer

receiving doctor

EQUIPMENTS, DRUGS Familiar Adequate battery back up for monitor, Check, o2 cylender- suction , defib.

Empty drainage bags

TRANSPORT PLAN AND CONDUCT Pt. special need

Staff- adequacy, awareness of responsibility

Receiving facility- informed, prepared

specific transport condition….road, distance, weather, vehicle, lighting

Check the route Proper take over by receiving team

DOCUMENTATION Clinical status before, during , after

transfer

Pt. condition- trend

Medicolegal implications

In end, evaluate process of transfer- for quality improvement

NO TRANSFER without fixing ABC…

Secure Airway when doubt, borderline indication- INTUBATION

Adequate i. v. access-

Unco-operative pt. without secured airway- very dangerous –

Put URINARY CATH, RT, CVC in indicated pt.

before transfer.not

Do not remove support , monitoring before TRANSPORT