Neonatal and Pediatric Transport

Neonatal and Pediatric Transport is a complicated and delicate process for clinicians. This short book is intended to help give an overview of critical care transport for the pediatric and neonatal patient. Core Knowledge Professional Issues Scope of practice of all team members Federal regulations regarding transport EMATALA EMTALA is the Federal Emergency Medical Treatment and Labor Act, also known as COBRA. EMTALA is a statute which governs when and how a patient must be: examined and offered treatment or transferred from one hospital to another when he is in an unstable medical condition. EMTALA applies only to "participating hospitals" under Medicare i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients. When is a patient considered stabalized? (for emergency medical conditions) that no material deterioration of the patient's condition is likely to result from the transfer or is likely to occur during the transfer; (for patients in active labor) the infant and the placenta have been delivered. FAA Informed consent Documentation Transport Environment Environmental Influences Barometric pressure effects Gravitational forces Noise Thermal & humidity effects Vibration Safety Scene safety Evacuation protocols Survival training Disaster planning Crew Stress Environmental Physical Psychological Communication Peer to peer Patient (age appropriate) Parents & family members Transport-related Clinical Management and Skills Cardiopulmonary Arrest (NRP & PALS) Airway Breathing Circulation Thermal Management Hypothermia Hyperthermia Special Skills Intubation Laryngeal mask airway Needle cricothyroidotomy Intravenous /intraosseous Access Insert UVC/UAC Needle aspiration/chest tube insertion Pericardiocentesis Troubleshooting Physical assessment Anatomic abnormalities Developmental/behavioral status Fluid & electrolyte therapy Dehydration Fluid overload Electrolyte abnormalities Infection control issues Principles of mechanical ventilation support during transport Pharmacology Pain management Sedation Physiologic impacts Fluid dynamics Gas changes Laws of science Boyle's Law Charles Dalton's Law The partial pressure of an ideal gas in a mixture is equal to the pressure it would exert if it occupied the same volume alone at the same temperature. This is because ideal gas molecules are so far apart that they don't interfere with each other at all. Actual real-world gases come very close to this ideal. A consequence of this is that the total pressure of a mixture of ideal gases is equal to the sum of the partial pressures of the individual gases in the mixture as stated by Dalton's law.Dalton's Law of Partial Pressures For example, given an ideal gas mixture of nitrogen (N2), hydrogen (H2) and ammonia (NH3): where:  = total pressure of the gas mixture= partial pressure of nitrogen (N2)= partial pressure of hydrogen (H2)= partial pressure of ammonia (NH3) Oxygen consumption Spatial changes Third spacing Neonatal Pulmonary Upper Airway Congenital anomalies Choanal atresia Pierre Robin syndrome Lower Airway Chronic lung disease Parenchymal Aspiration Pneumonia/pneumonitis Respiratory distress syndrome Air leak syndrome Respiratory Failure Cardiovascular Congenital heart conditions Cyanotic Ductal dependent lesions Left to right shunting Persistent pulmonary hypertension of newborn (PPHN) Shock States Anaphylactic Cardiogenic Distributive (septic) Hypovolemic Congestive heart failure Pericarditis Dysrhythmias Bradycardia Tachycardia Supraventricular tachycardia (SVT) 11.03 Gastrointestinal Necrotizing enterocolitis 11.04 Metabolic Hypoglycemia Altered electrolyte balance 11.05 CNS/Neurological Seizures Perinatal substance abuse Increased intracranial hemorrhage 11.06 Surgical Emergencies Diaphragmatic hernia Gastroschisis Omphalocele Tracheoesophageal fistula 11.07 Special Situations -Care of the Extremely Low Birthweight (ELBW) patient in transport Pediatric Pulmonary Upper Airway Croup (laryngotracheobronchitis) Epiglottis Lower Airway Asthma Cystic fibrosis Parenchymal Pneumonia/pneumonitis Foreign Body Obstruction Cardiovascular Congenital Heart Late presentation Long term complications Postoperative cardiovascular procedure Hypertension Shock States Anaphylactic Cardiogenic Distributive (septic) Hypovolemic Congestive heart failure Pericarditis Dysrhythmias Bradycardia Tachycardia Supraventricular tachycardia (SVT) Gastrointestinal Acute obstruction Hemorrhage Volvulus Hematologic Anemia Sickle cell crisis Hemophilia Metabolic/Endocrine Diabetic ketoacidosis Altered electrolyte balance Thyroid storm CNS/Neurological Increased intracranial pressure Status epilepticus Coma Meningitis Intracranial hemorrhage Special Situations Bites (Poisonous and non-poisonous) Ingestions/Poisoning Near drowning Hypothermia/Hyperthermia Trauma Accidental Non-accidental Disaster-Related Blast injury Radiation exposure Multi-system Burns and smoke inhalation Sepsis