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Neonatal and Pediatric Transport

Neonatal and Pediatric Transport. Tintinalli Chap. 4. Regionalized Intensive Care. Expensive, high-technology, labor-intensive therapies limited to a few regional centers. Transport Environment. Noise Vibration Inadequate lighting Temperature Humidity Altitude Confined space.

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Neonatal and Pediatric Transport

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  1. Neonatal and Pediatric Transport Tintinalli Chap. 4

  2. Regionalized Intensive Care • Expensive, high-technology, labor-intensive therapies limited to a few regional centers

  3. Transport Environment • Noise • Vibration • Inadequate lighting • Temperature • Humidity • Altitude • Confined space • Limited support • Equipment failure

  4. Minimizing Impact • Prepare the transport vehicle • Stabilize the patient • Monitor as many physiologic parameters as possible • Heart rate, respirations • Pulse oximetry • Body temperature • CO2 • Blood pressure • Portable blood analyzer • Anticipate deterioration

  5. Preparation for Transport • S.T.A.B.L.E. • Sugar • Temperature • Airway • Blood pressure • Laboratory evaluation • Emotional support

  6. Airway Management • Goals • Protect from obstruction • Ensure adequate ventilation • Provide adequate oxygenation • Threshold to intubate

  7. Neonatal Intubation • Positioning • Depth of insertion • Assistance • Taping

  8. Vascular Access • At least 2 lines in critical patients • Peripheral • Umbilical vessels • IO • Monitor fluids

  9. Hypoglycemia • Most common metabolic abnormality in newborns • All neonates should receive glucose-containing fluids • Glucose of at least 50

  10. Hypothermia • Dry infants thoroughly • Place on prewarmed surface • Neutral thermal environment • Room temp • Thermo-controlled beds • Properly clothed

  11. Hypoxemia • Respiratory Distress Syndrome • Persistent Pulmonary HTN of the Newborn • Cyanotic Congenital Heart Disease

  12. Respiratory Distress Syndrome • Progressively worsening retractions, tachypnea, and oxygen requirements • Immature lungs to do not synthesize surfactant • CXR shows “ground glass” opacities and prominent air bronchograms • Treatment • CPAP • Intubation and surfactant through ET tube

  13. Persistent Pulmonary HTN • Labile oxygenation despite adequate ventilation • Right-to-left shunt • Detected by taking pulse oximetry on hand and foot • Hand > Foot by 10% or more • Treatment aimed at optimizing pulmonary blood flow • Intubation • 100% oxygen • Correction of acidosis • Maintenance of high-normal blood pressures • Maintenance of normal hematocrit • Correction of metabolic abnormalities • Sedation/paralysis

  14. Cyanotic Heart Disease • Clinically silent until closure of ductusarteriosus • Diagnosis • ABG’s on 100% O2 • Echo • Treatment • Supportive • PGE1

  15. Hypotension • Causes • Hypovolemia • Cardiogenic failure • Sepsis • Signs • Weak peripheral pulses • Cyanosis • Capillary refill > 3 sec • Cool mottled skin • Treatment • Volume resusciatation • PRBC’s • Inotropic agents

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