Download Document

In Flight Patient Care
Considerations for:
Gastrointestinal/Genitourinary
Orthopedic
EENT
Objective
• Apply knowledge of flight physiology and
aviation environmental stressors in the
planning and delivery of pre-flight and inflight care of patients with cardiopulmonary,
gastrointestinal, genitourinary, neurological,
ophthalmologic, otorhinolaryngologic,
orthopedic, and burn injuries and conditions
General Considerations
• Preflight
Mode of transport
Patient Assessment
Supplies
Equipment
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
Gastrointestinal/Genitourinary
Conditions
• GI system encompasses 26 feet of liquid
and gas-producing viscus
• Average GI tract has approximately 1liter of
gas present at any one time
• Unrelieved GI gas expansion at altitude
may produce pain, respiratory difficulty,
lead to vasovagal reaction resulting in
hypotension, tachycardia, syncope
Gastrointestinal/Genitourinary
Conditions
• Preflight Assessment
Diagnosis and treatment to date
Assess bowel sounds
Check NG for placement and patency
Check urinary/suprapubic catheters for
patency and output
Assess vital signs, surgical sites, supplies
and patency of other access lines
Gastrointestinal/Genitourinary
Conditions
• Stresses of flight
Decreased partial pressure of oxygen
Decreased humidity
Barometric pressure changes
GI/GU Conditions
• In-flight considerations
Transport after abdominal surgery delayed
24-48 hours – air pockets may remain in
abdominal cavity post-op can lead to emboli
Movement within first 24 hours of
abdominal surgery or GI trauma from
Primary Blast Injury requires altitude
restriction
GI/GU Conditions
• In-flight considerations
Hypothermia and coagulopathy
continuing problem – continue to provide
warmed fluids in flight, keep patient
warm
Treat hypotension with judicious fluid
bolus (4ml/KG) usually 250-500ml at a
time
Monitor urine output – minimum 30ml/hr
GI/GU Conditions
• In-flight considerations
NG/OG to gravity or suction – never clamp,
do not inject air –expands at altitude
Pain meds, antibiotics
Head elevated 30 degrees
GI/GU Conditions
• Surgical stabilization for liver, spleen,
pancreas, intestinal trauma complicated by
sepsis, wound infection, abscess formation
 Administer antibiotics
 Check surgical drains
 Wound vacuums
 Bogota bags
 Reinforce dressings – contaminated
environment
Orthopedic Conditions
• Preflight Assessment
Diagnosis and treatment to date
Neurovascular checks – proximal and distal
to injury, compare to non-injured extremity
Vital signs, POX, Hgb, IVF, urine output
Antibiotics, pin sites, fasciotomies
Pain control
Orthopedic Conditions
• Stresses of flight
Barometric pressure changes
Vibration
G-forces
Decreased partial pressure oxygen
Orthopedic Conditions
• General Care
Position on aircraft so that injured extremity
is not against bulkhead/frame
Elevate injured limb, keep immobilized
Neurovascular checks
Administer pain meds and antibiotics
Check dressings, fasciotomies –drainage
Orthopedic Conditions
• General Care
Monitor urine output – crush injuries
maintain output >50ml/hr, assess for need
for alkalinizing urine prior to transport
Supply supplemental oxygen for Hgb <8.5
Possible altitude restriction for crush
injuries, compartment syndromes, major
bleeds s/p pelvic fracture
Orthopedic Conditions
• General Care
Casts/Splints – bivalve plaster casts, no air
splints
Orthopedic Injuries
• Fat Emboli
Commonly associated with femur, long
bone fractures
Clinically manifests at 4hours to 4 days
post-trauma –avg time 12-48 hours
Cardinal sign – petecchial rash upper trunk,
axilla, chest, conjunctiva
Orthopedic Injuries
• Fat Emboli
Accompanied by mental status changes,
agitation, acute dyspnea, tachypnea,
tachycardia, dysrhythmias, chest pain,
ARDS
Intubate, ventilate, IV RL, supportive
treatment of shock
Orthopedic Injuries
• Fat Emboli
Accompanied by mental status changes,
agitation, acute dyspnea, tachypnea,
tachycardia, dysrhythmias, chest pain,
ARDS
Intubate, ventilate with peep, IV RL,
supportive treatment of shock
EENT Injuries
• Eye Injury Preflight Assessment
Diagnosis, treatment
Vital signs, POX
Assessment of associated injuries with
focus on airway
Establish communication plan
EENT Injuries
• Stresses of Flight
Barometric Pressure changes – air bubble
expansion along penetration tract, decreased
blood flow leads to increase pain
Decreased Partial pressure O2 –hypoxia
dilates vessels leading to hemorrhage and
increased IOP
Decreased humidity – eye dryness
EENT Injuries
• Stresses of Flight
Vibration – pain due to constant vibration
leads to motion sickness
EENT Injuries
• In-flight Considerations Eye Injuries
Cabin Altitude Restriction 4000ft and under
Shield both eyes
O2 administration especially for retinal
injuries
Elevate head to decrease IOP
Artificial tears, pain medications,antibiotics
EENT Injuries
• In-flight Considerations Eye Injuries
Antiemetic, immobilize head to prevent
motion sickness
Eye injury/ post-op repair should NEVER
VALSALVA-Toynbee maneuver
Avoid use of succinylcholine for RSI –
increases IOP
EENT Injuries
• Preflight Assessment Ear Injuries
Diagnosis, treatment
Vital signs, physical assessment
History of associated injuries – focus on
airway
Type of aircraft
Length of exposure
EENT Injuries
• Stresses of flight Ear Injuries
Barometric pressure changes – ear blocks
Noise
Vibration
EENT Injuries
• In-flight Care Ear Injuries
Primary Blast Injury, post-op surgery
middle ear – Altitude Restriction 4000 feet
or under
Hearing protection even if PBI with
tympanic rupture
Increased sensitivity to motion sickness –
pre-medicate
EENT Injuries
• Preflight Assessment Maxillofacial Injuries
Diagnosis, treatment
Type of airway and patency
Type of jaw immobilization if present
Vital signs, POX, IVF, Hgb
Presence of NG/OG and patency
Medications
EENT Injuries
• Stresses of flight Maxillofacial Injuries
Barometric pressure changes
Decreased humidity
EENT Injuries
• In-flight considerations Maxillofacial
Injuries
Altitude restriction for sinus involvement
and inability to valsalva
Wire cutters, quick-release for jaw
immobilization
Pre-medicate with vasoconstrictor – Afrin
Provide humidification, suction as needed
EENT Injuries
• In-flight considerations Maxillofacial
Injuries
Evaluate for pain/nausea and medicate
Tracheostomy balloon filled with saline
Elevate head
EENT Injuries
• In-flight considerations Posterior Nose
Bleed
IV fluid boluses to maintain SBP >90
Control bleeding – Foley catheter inserted
through nostril to posterior pharynx, inflate
balloon and withdraw until bleeding is
controlled. Mid-face injuries nasal packing
Break Time/Questions???