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.

Core Knowledge[edit | edit source]

Professional Issues[edit | edit source]

Scope of practice of all team members[edit | edit source]

Federal regulations regarding transport[edit | edit source]

EMATALA[edit | edit source]

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:

  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 | edit source]

Informed consent[edit | edit source]

Documentation[edit | edit source]

Transport Environment[edit | edit source]

Environmental Influences[edit | edit source]

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

Safety[edit | edit source]

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

Crew Stress[edit | edit source]

Environmental[edit | edit source]
Physical[edit | edit source]
Psychological[edit | edit source]

Communication[edit | edit source]

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

Transport-related Clinical Management and Skills[edit | edit source]

Cardiopulmonary Arrest (NRP & PALS)[edit | edit source]

Airway[edit | edit source]
Breathing[edit | edit source]
Circulation[edit | edit source]

Thermal Management[edit | edit source]

Hypothermia[edit | edit source]
Hyperthermia[edit | edit source]

Special Skills[edit | edit source]

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

Physical assessment[edit | edit source]

Anatomic abnormalities[edit | edit source]

Developmental/behavioral status[edit | edit source]

Fluid & electrolyte therapy[edit | edit source]

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

Infection control issues[edit | edit source]

Principles of mechanical ventilation support during transport[edit | edit source]

Pharmacology[edit | edit source]

Pain management[edit | edit source]
Sedation[edit | edit source]

Physiologic impacts[edit | edit source]

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

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):

where:  
= total pressure of the gas mixture
= partial pressure of nitrogen (N2)
= partial pressure of hydrogen (H2)
= partial pressure of ammonia (NH3)
Oxygen consumption[edit | edit source]
Spatial changes[edit | edit source]
Third spacing[edit | edit source]

Neonatal[edit | edit source]

Pulmonary[edit | edit source]

Upper Airway[edit | edit source]

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

Lower Airway[edit | edit source]

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

Respiratory distress syndrome[edit | edit source]

Air leak syndrome[edit | edit source]

Respiratory Failure[edit | edit source]

Cardiovascular[edit | edit source]

Congenital heart conditions[edit | edit source]

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

Congestive heart failure[edit | edit source]

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

11.03

Gastrointestinal[edit | edit source]

Necrotizing enterocolitis[edit | edit source]

11.04

Metabolic[edit | edit source]

Hypoglycemia[edit | edit source]

Altered electrolyte balance[edit | edit source]

11.05

CNS/Neurological[edit | edit source]

Seizures[edit | edit source]

Perinatal substance abuse[edit | edit source]

Increased intracranial hemorrhage[edit | edit source]

11.06

Surgical Emergencies[edit | edit source]

Diaphragmatic hernia[edit | edit source]

Gastroschisis[edit | edit source]

Omphalocele[edit | edit source]

Tracheoesophageal fistula[edit | edit source]

11.07

Special Situations[edit | edit source]

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

Pediatric[edit | edit source]

Pulmonary[edit | edit source]

Upper Airway[edit | edit source]

Croup (laryngotracheobronchitis)[edit | edit source]
Epiglottis[edit | edit source]

Lower Airway[edit | edit source]

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

Foreign Body Obstruction[edit | edit source]

Cardiovascular[edit | edit source]

Congenital Heart[edit | edit source]

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

Shock States[edit | edit source]

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

Congestive heart failure[edit | edit source]

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

Gastrointestinal[edit | edit source]

Acute obstruction[edit | edit source]

Hemorrhage[edit | edit source]

Volvulus[edit | edit source]

Hematologic[edit | edit source]

Anemia[edit | edit source]

Sickle cell crisis[edit | edit source]

Hemophilia[edit | edit source]

Metabolic/Endocrine[edit | edit source]

Diabetic ketoacidosis[edit | edit source]

Altered electrolyte balance[edit | edit source]

Thyroid storm[edit | edit source]

CNS/Neurological[edit | edit source]

Increased intracranial pressure[edit | edit source]

Status epilepticus[edit | edit source]

Coma[edit | edit source]

Meningitis[edit | edit source]

Intracranial hemorrhage[edit | edit source]

Special Situations[edit | edit source]

Bites (Poisonous and non-poisonous)[edit | edit source]

Ingestions/Poisoning[edit | edit source]

Near drowning[edit | edit source]

Hypothermia/Hyperthermia[edit | edit source]

Trauma[edit | edit source]

Accidental[edit | edit source]

Non-accidental[edit | edit source]

Disaster-Related[edit | edit source]

Blast injury[edit | edit source]
Radiation exposure[edit | edit source]

Multi-system[edit | edit source]

Burns and smoke inhalation[edit | edit source]

Sepsis[edit | edit source]

  1. Dalton's Law of Partial Pressures