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In-Flight Patient Care Considerations For: O2 utilization Cardiac pulmonary Mechanical Vent Chest tubes.

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Presentation on theme: "In-Flight Patient Care Considerations For: O2 utilization Cardiac pulmonary Mechanical Vent Chest tubes."— Presentation transcript:

1 In-Flight Patient Care Considerations For: O2 utilization Cardiac pulmonary Mechanical Vent Chest tubes

2 Objective Apply knowledge of flight physiology and aviation environmental stressors in the planning and delivery of pre-flight and in-flight care of patients with cardiopulmonary, gastrointestinal, genitourinary, neurological, ophthalmologic, otorhinolaryngologic, orthopedic, and burn injuries and conditions

3 General Considerations
Preflight Mode of transport Patient Assessment Supplies Equipment

4 General Considerations
IV flow rates without pump O2 conversion table – sea level equivalent Securing patient and equipment Securing self Reliance on low tech physical assessment Hearing protection for patient and ERC personnel

5 Oxygen Utilization Rate
Tank Factors D cylinder = 0.16 E cylinder = 0.28 H cylinder = 3.14 Calculating Duration of Cylinder Flow Gauge PSI – safety residual x tank factor liter flow per minute

6 Batteries 2-3 hour life when fully charged Have manual back-ups
Cigarette light re-chargers Platform electrical source

7 Cardiac Considerations
Preflight assessment Diagnosis Vital signs, presence of pain, signs of failure, cardiac rhythm, lung and heart sounds Treatment rendered

8 Cardiac Considerations
Stresses of flight Lower partial pressure O2 (hypoxia) Barometric pressure changes Thermal changes Fatigue

9 Cardiac Considerations
In-flight care IV, O2, monitor - maintain POX >95%, maintain SBP >90, monitor urine output Pain relief – ASA, Nitrates, Morphine Elevate head degrees Avoid valsalva – Toynbee maneuver

10 Cardiac Considerations
In-flight care Position patient to minimize temperature changes, prevent hypo and hyperthermia Diuretics for failure Altitude restriction under 6,000 ft cabin altitude

11 Cardiac Arrest Considerations
Limited ACLS drugs, space confinements Prior to use of defibrillator – notify pilot Defibrillation – Follow ACLS guidelines – be aware of motion induced interruptions. Extra precautions in “all clear”. Transcutaneous pacing – electromagnetic interference

12 Pulmonary Considerations
Airway and ventilation management is the first priority of patient care. Altitude Hypoxia affects all patients transported by air. Common mistake is to fail to anticipate the need for a secure airway in patients at high risk

13 Pulmonary Considerations
Six general indications for securing an airway Apnea Upper airway obstruction Airway protection Elevated intracranial pressure requiring tight pCo2 control Respiratory insufficiency Impending or potential airway compromise (prophylactic intubation)

14 Altitude Restrictions
At 7,000ft cabin altitude normal person’s PaO2=60 mm Hg and POX=90% Most commercial aircraft pressurized between 5,000-8,000 ft. Military 8,500 ft. Patients with a PaO2 below 60 mm Hg or sat 90% will develop hypoxic hypoxia at altitudes between 2,000-4,000ft.

15 Altitude Restrictions
Altitude Restrictions Required Free air in any cavity – GI tract, lung, skull, middle ear, sinuses, and teeth Cardiac with angina, MI, effusion Eye Injuries Hgb < 7

16 Pulmonary Considerations
Preflight Assessment Diagnosis and treatment to date Airway assessment Baseline vital signs, ABGs, ventilator settings, POX Hgb, fluids Physical assessment, PMH

17 Pulmonary Considerations
Stresses of Flight Lowered partial pressure of oxygen Decrease humidity Barometric pressure changes Thermal changes Noise, positive G-forces

18 Pulmonary Considerations
In-flight care Elevate head Treat or avoid hypo/hyperthermia Judicious administration of IV fluids if hypovolemia absent Oxygen administration to maintain baseline POX

19 Oxygen Conversion Table

20 Mechanical Ventilation
Dalton’s Law Effects ALL gases – pCo2 will be affected also – important to monitor ETCO2 - maintain ETCO2 range 30-40 Boyle’s Law Effects air in ET and trach tubes – replace with NS prior to flight

21 Mechanical Ventilation
Boyle’s Law Closely monitor Tidal Volumes and delivery pressures Sufficient amounts of NMBA and sedative/analgesic medications Familiarity with RSI/intubation techniques,

22 Mechanical Ventilation
Effects of decreased humidity Can lead to airway plugs from desiccation of mucous – monitor airway pressures Trach patients not requiring oxygenation, still require warmed humidification

23 Mechanical Ventilation
Logistic considerations Position ventilator on litter below patient, secure but ensure access and visibility Ensure tubing secured to avoid drag and possible extubation Ensure B-V-M, manual suction

24 Pulmonary Emergencies
Even minor, occult pneumothorax (PTX) will expand at altitude Emphysematous blebs risk for rupture in non-ventilated patients MV patients suspect PTX with acute desaturations, increasing airway pressures Have needle thoracostomy equipment and be prepared to use it

25 Chest Tubes Chest Drainage Units
Even arid units have H2O in the water seal Check water seal chamber after descent Collection chamber must be marked hourly and after each descent Check water levels after ascent Decreased humidity leads to evaporation in suction control chamber, check frequently

26 Chest Tubes Heimlich Valve – due to distinct characteristics of flight necessary to ensure safe transport Emergency egress Prevents lung collapse from loss of water seal during descent (fixed wing)

27 Chest Tubes Heimlich Valve
Connected between the chest tube and drainage unit Ends secured with tape Assess frequently for proper function Always carry an extra valve

28 Break Time/Questions???

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