Transport of the Critically Ill - Kbk

7/30/2019 Transport of the Critically Ill - Kbk

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Departemen/SMF - Anestesi dan Terapi Intensif

FK USU/RSUP H. Adam Malik Medan


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TRANSPORT OF PATIENTS

PRIMARY TRANSPORT

SECONDARY TRANSPORT

AIR TRANSPORT

NEONATAL TRANSPORT

PEDIATRIC TRANSPORT


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PRIMARY TRANSPORT

The management and transport of

a patient from an accident side to

the closest available adequatemedical facility.


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THE EARLIEST , THE BETTER


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SECONDARY TRANSPORT

When the patient needs to be transferred

to a second hospital or has to be moved

within the same hospital to a differentsite (e.g. from the Intensive Care Unit to

the Scanner Room)


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Air Medivac


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Primary Secondary

Location Prehospital to Hospital Inter or Intrahospital

PurposeInitial stabilization,

evacuation

Stabilization,

definitive care

Vehicle Ground, HelicopterGround, Helicopter,

Plane

Patient Potentially unstable Stabilized

Time factorShort response time

critical

Speed may be less

critical

Organization EMS prehospital EMS hospital -based

Primary versus Secondary Transport

EMS : Emergency Medical Services


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Sampaikan data- fungsi vital

- Rx yang sudah

diberikan

RS penerima dapat

menyiapkan fasilitas

dan terapi lanjutan


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JENIS TRANSPORTASI

Darat

jarak & lama

permukaan rata / kasar kemiringan dan arah trayek

Udara

ketinggian = tekanan udara, tekananO2


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G-force


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Pertahankan posisi korban tetap datar

selama diangkut


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Atap tinggi

agar dapat bekerjadi dalamnya

Head-clearance tinggi

Petugas dapat memberipertolongan lanjutan

seraya ambulans jalan


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Airway, Intubation, Suction

Neck Collar, sandbags

Oxygen, Ambu-bag, Ventilator

BP, infusion, bandages

Drugs (vasopressor)

EKG & DC shock

Stretcher, splint


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Tanda

klinis

shock

Nafas cepat

Kulit dingin, pucat, basah,

sianosis Capillary refill time > 2 detik


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Kalau ada ragu, kerjakan!

In doubt, do

Jalan nafas intubasi

Pneumotoraks chest drain


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Bawa cadangan Oksigen, Cairan perjalanan bisa tertunda

Jalan jangan terlalu cepat

Bila jalan menurun atau mendaki panjang, sesuaikan letak kepala


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Jalan menurunGravitasi ke kepala

Aliran darah ke kepala

Tekanan Intra Kranial naik


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Jalan mendakigravitasi ke kaki

Aliran darah ke otak


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Minimum Equipment that shall

be available

For Airway and Ventilatory Management:

Oxygen source

Suction apparatus and Catheters

Cardiac Monitor/Defibrillator

Blood Pressure Cuff

Pulse OxymetryMaterials for IV therapy: cannulas,

solutions, tubing, needles and syringe

Drugs for advanced Cardiac Resuscitation


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Monitoring during transport:

Continuous EKG monitoring

Intermittent measurement of:

Blood Pressure

Respiratory Rate

Continuous monitoring by Pulse Oximetry isstrongly recommended

Intubated patients receiving mechanical supportof ventilation should have airway pressuremonitored


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Standard Resuscitation Drugs

Sulfas Atropine

Epinephrine

Dobutamin

Lidocaine

Sodium Bicarbonat

Muscle Relaxant Sedative

Dexamethasone


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Risk to the patient during

transport can be minimized :

Careful Planning

Use of appropriately qualified Personnel Selection of appropriate equipment

The available equipment and skill level

of the accompanying personnel must beequal to the interventions or anticipated

for the patient


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Personnel who accompany the

patient:

A minimum of two people

shall accompany the patient : Physician

Critical Care Nurse


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The Basic Reason for Moving a

Critically Ill Patient is :

The need for additional care

Technology

Specialists

Nurse

not available at the

patients current location

Society of Critical Care Medicine: Guidelines for the Transfer of Critically Ill

Patients. Crit Care Med 1993 June,21(6):931-937


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Kabin bertekanan pada

pesawat komersial =

tekanan udara pada tinggi 3000m= risiko hipoksia

Dalam helikopter

banyak gangguan suara

dan gelombang elektromagnetik

Perubahan tekanan = risiko:- udara dalam botol infus

- udara dalam pneumothorax

- letak botol WSD

Terbang ketinggian > 3000 m

tanpa kabin bertekanan

|

risiko hipoksia


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Kabin bertekanan pada

pesawat komersial =tekanan udara pada tinggi 3000m

= risiko hipoksia


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Tulonnngggggggg

Gue masih pengen

Hidup . . . . . .


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Thank you

foryourAttention

Documents

Transport of the Critically Ill - Kbk