STABILIZING PATIENTS RAPIDLY FOR INTERFACILITY TRANSPORT: THE SPRINT
STABILIZING PATIENTS RAPIDLY FOR INTERFACILITY TRANSPORT: THE SPRINT COURSE Assistance Advisors Burns Jim Johnson MD Christopher Lentz MD Cardiac
Charles Bethea MD Raj Chandwaney MD Neurology David L. Gordon MD Anna Wanahita MD Obstetrics Michael Gardner MD Pediatrics Amanda L. Bogie MD Michael Gomez MD
Cecilia C. Guthrie MD Surgery & Trauma John Blebea MD Jason Lees MD Michael Charles MD Referring Facility Stabilizing Patients Rapidly for
INTerfacility transport Course overview & 5 Ws General principles/steps for all patients Principles related to specific diagnoses Recommendations summary Post-course follow-up & plans Discussion outline Receiving
Hospital SPRINT overview: 5 Ws What is SPRINT? Why a new program? Who are audience targets? Where and when are courses?
SPRINT general principles Core message: Fast, Safe, and Sound Strive for quickness (while avoiding haste) Keep patient safety as top priority Practice sound, evidence-based medicine Goal: Minimize HEMS time at referring hospital Time HEMS crew spends at patients bedside SPRINTs focus: Patient stabilization time (PST)
SPRINT goal: Streamline PST Efficiency is desirable in any acute patient Incremental benefit with time savings Trauma Vascular emergencies Categorical endpoint: meeting time window Percutaneous coronary intervention for STEMI Lysis therapy for ischemic stroke (iCVA)
SPRINT and patient care timeline SPRINT time frame after transport decision SPRINT is not intended to address: Making decision to transport Determining transport mode/service Designating receiving facility SPRINT is not meant to dictate transport decisions, modalities, or receiving centers SPRINT steps: Initial information
Referring & receiving hospital data Unit, physician, contact info Bed status: Ready, not ready, etc. Patient parameters Name and birthdate Complaint/transport reason Height, weight & widest girth SPRINT steps: Initial info
Additional clinical parameters Medications Equipment (eg. pumps, vent) Safety (eg. patient agitation) Other issues Will family be at referring hospital with patient? Weather questions on referring hospital end SPRINT steps: Logistics & paperwork Prepare the LZ and personnel
Refer to LZ training courses Prepare to assist crew as needed SPRINT steps: Airway #1 issue (for flight crews & receiving doctors) Endotracheal intubation (ETI) problems: HEMS ETI is widely perceived as too frequent Flight crew ETI is associated with prolonged PST Flight crew can offer significant ETI expertise Decision on ETI pre-transport vs. in-flight:
Estimation of ETI difficulty isnt always precise Patient and logistics factors contribute to decision Bottom line: Situational judgment is best Guides to assist referring providers: If airway needs management, manage it When in doubt, secure airway Discuss prn with en route crews When airway is managed Describe difficulties to crew Note airway, size, and depth
2 functioning and secured lines usually required If IV access is problematic, alert en route HEMS crew Fluids: Discuss with receiving; prepare infusates SPRINT steps: Circulation SPRINT steps: Medications Drug Rx often causes preventable delays Execute/consider following time savers:
Administer all ordered medications Clarify allergies Anticipate medications that may be needed Alert transport crews to drugs/times given: Antibiotics Analgesics Sedatives Paralytics
Fully completed Partly complete Planned/ordered Admin times for key meds Analgesia Antiepileptics
Sedation Paralytics 4) Ventilator patients Airway/lung assessment ETI medications/problems
ETT size, depth ETT confirmation method Vent changes/responses 5) Summarize working dx 6) Ask if report complete 7) Receiving crew review Presentation key points Interventions/meds Points to consider Diagnosis-specific principles
Burns Cardiac Neurology Obstetrics Pediatrics Trauma Vascular Streamlining PST: Burns 1) Airway: Aggressive can be conservative
Inhalational/airway, facial burns: ETI likely Save PST on by managing airway early 2) Fluids (warm if possible) Use formula (BRI, Parkland) to calculate fluids Monitor and report urine output 3) Dressings: Use minimalist approach 4) Thermoregulation: Keep patients warm Streamlining PST: STEMI for PCI
1) Administer meds ASA almost always No clopidogrel Heparin bolus 50-70 u/kg 2) No IV infusions No heparin drip No nitroglycerin drip 3) Consider R-sided EKG 4) Gown patient
Streamlining PST: Seizures 1) Stop seizures 2) Report what worked (and when) 3) Avoid paralytics Streamlining PST: Stroke 1) Avoid paralytics 2) Generate BP plan Hemorrhage mgmt?
Lysis-eligible: 185/110 Post-lysis: 180/105 Streamlining PST: Obstetrics 1) 2) 3) 4) Transport by air?: Contractions and cervix Perfusion: left lateral decubitus position Analgesics and antiemetics (both are fine)
BP control: Formulate plan and start treating Streamlining PST: Pediatrics Airway: Intubate if needed Watch tube size/depth Streamlining PST: Pediatrics VS: Pay attention to BP cuff, SpO2 site, temp Fluids: Make plan for fluids and have them ready
Streamlining PST: Trauma Airway, breathing, and circulation Consider managing airway Assure IV access in place Foley catheters Assure infusates (e.g. blood) are ready
Recovery of aggregation was delayed after abciximab, but rapid after tirofiban and eptifibatide. These results were confirmed by conventional platelet aggregometry. Thus, tirofiban, abciximab, and eptifibatide, at currently recommended doses, achieved an adequate inhibition of platelet aggregation.
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ICAO WGN New Orleans 10-19 Nov 2004 Programme Overview Incentives and a Mandate Issues Conclusion Programme Overview Incentives and a Mandate Issues Conclusion Contents Programme Objectives The LINK 2000+ Programme Co-ordinating the implementation of en-route CPDLC (ACM, ACL, AMC, DLIC)...
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