Neonatal and Pediatric Transport

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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.

Contents

Core Knowledge[edit]

Professional Issues[edit]

Scope of practice of all team members[edit]

Federal regulations regarding transport[edit]

EMATALA[edit]

EMATALA is the Federal Emergency Medical Treatment and Labor Act, also known as COBRA. EMATALA is a statute which governs when and how a patient must be:

  1. examined and offered treatment or
  2. 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?
  1. (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;
  2. (for patients in active labor) the infant and the placenta have been delivered.
FAA[edit]

Informed consent[edit]

Documentation[edit]

Transport Environment[edit]

Environmental Influences[edit]

Barometric pressure effects[edit]
Gravitational forces[edit]
Noise[edit]
Thermal & humidity effects[edit]
Vibration[edit]

Safety[edit]

Scene safety[edit]
Evacuation protocols[edit]
Survival training[edit]
Disaster planning[edit]

Crew Stress[edit]

Environmental[edit]
Physical[edit]
Psychological[edit]

Communication[edit]

Peer to peer[edit]
Patient (age appropriate)[edit]
Parents & family members[edit]

Transport-related Clinical Management and Skills[edit]

Cardiopulmonary Arrest (NRP & PALS)[edit]

Airway[edit]
Breathing[edit]
Circulation[edit]

Thermal Management[edit]

Hypothermia[edit]
Hyperthermia[edit]

Special Skills[edit]

Intubation[edit]
Laryngeal mask airway[edit]
Needle cricothyroidotomy[edit]
Intravenous /intraosseous Access[edit]
Insert UVC/UAC[edit]
Needle aspiration/chest tube insertion[edit]
Pericardiocentesis[edit]
Troubleshooting[edit]

Physical assessment[edit]

Anatomic abnormalities[edit]

Developmental/behavioral status[edit]

Fluid & electrolyte therapy[edit]

Dehydration[edit]
Fluid overload[edit]
Electrolyte abnormalities[edit]

Infection control issues[edit]

Principles of mechanical ventilation support during transport[edit]

Pharmacology[edit]

Pain management[edit]
Sedation[edit]

Physiologic impacts[edit]

Fluid dynamics[edit]
Gas changes[edit]
Laws of science[edit]
Boyle's Law[edit]
Charles[edit]
Dalton's Law[edit]

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.[1] For example, given an ideal gas mixture of nitrogen (N2), hydrogen (H2) and ammonia (NH3):

P = P_{{\mathrm{N}}_2} + P_{{\mathrm{H}}_2} + P_{{\mathrm{NH}}_3}
where:  
P \, = total pressure of the gas mixture
P_{{\mathrm{N}}_2} = partial pressure of nitrogen (N2)
P_{{\mathrm{H}}_2} = partial pressure of hydrogen (H2)
P_{{\mathrm{NH}}_3} = partial pressure of ammonia (NH3)
Oxygen consumption[edit]
Spatial changes[edit]
Third spacing[edit]

Neonatal[edit]

Pulmonary[edit]

Upper Airway[edit]

Congenital anomalies[edit]
Choanal atresia[edit]
Pierre Robin syndrome[edit]

Lower Airway[edit]

Chronic lung disease[edit]
Parenchymal[edit]
Aspiration[edit]
Pneumonia/pneumonitis[edit]

Respiratory distress syndrome[edit]

Air leak syndrome[edit]

Respiratory Failure[edit]

Cardiovascular[edit]

Congenital heart conditions[edit]

Cyanotic[edit]
Ductal dependent lesions[edit]
Left to right shunting[edit]
Persistent pulmonary hypertension of newborn (PPHN)[edit]
Shock States[edit]
  1. Anaphylactic
  2. Cardiogenic
  3. Distributive (septic)
  4. Hypovolemic

Congestive heart failure[edit]

Pericarditis[edit]
Dysrhythmias[edit]
Bradycardia[edit]
Tachycardia[edit]
Supraventricular tachycardia (SVT)[edit]

11.03

Gastrointestinal[edit]

Necrotizing enterocolitis[edit]

11.04

Metabolic[edit]

Hypoglycemia[edit]

Altered electrolyte balance[edit]

11.05

CNS/Neurological[edit]

Seizures[edit]

Perinatal substance abuse[edit]

Increased intracranial hemorrhage[edit]

11.06

Surgical Emergencies[edit]

Diaphragmatic hernia[edit]

Gastroschisis[edit]

Omphalocele[edit]

Tracheoesophageal fistula[edit]

11.07

Special Situations[edit]

-Care of the Extremely Low Birthweight (ELBW) patient in transport

Pediatric[edit]

Pulmonary[edit]

Upper Airway[edit]

Croup (laryngotracheobronchitis)[edit]
Epiglottis[edit]

Lower Airway[edit]

Asthma[edit]
Cystic fibrosis[edit]
Parenchymal[edit]
Pneumonia/pneumonitis[edit]

Foreign Body Obstruction[edit]

Cardiovascular[edit]

Congenital Heart[edit]

Late presentation[edit]
Long term complications[edit]
Postoperative cardiovascular procedure[edit]
Hypertension[edit]

Shock States[edit]

Anaphylactic[edit]
Cardiogenic[edit]
Distributive (septic)[edit]
Hypovolemic[edit]

Congestive heart failure[edit]

Pericarditis[edit]
Dysrhythmias[edit]
Bradycardia[edit]
Tachycardia[edit]
Supraventricular tachycardia (SVT)[edit]

Gastrointestinal[edit]

Acute obstruction[edit]

Hemorrhage[edit]

Volvulus[edit]

Hematologic[edit]

Anemia[edit]

Sickle cell crisis[edit]

Hemophilia[edit]

Metabolic/Endocrine[edit]

Diabetic ketoacidosis[edit]

Altered electrolyte balance[edit]

Thyroid storm[edit]

CNS/Neurological[edit]

Increased intracranial pressure[edit]

Status epilepticus[edit]

Coma[edit]

Meningitis[edit]

Intracranial hemorrhage[edit]

Special Situations[edit]

Bites (Poisonous and non-poisonous)[edit]

Ingestions/Poisoning[edit]

Near drowning[edit]

Hypothermia/Hyperthermia[edit]

Trauma[edit]

Accidental[edit]

Non-accidental[edit]

Disaster-Related[edit]

Blast injury[edit]
Radiation exposure[edit]

Multi-system[edit]

Burns and smoke inhalation[edit]

Sepsis[edit]

  1. Dalton's Law of Partial Pressures