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Download Critical Care Transport 2nd Edition – PDF – eBook

CHAPTER 1 Introduction and Overview of
Critical Care Transport 1
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Trends in Patient Transportation . . . . . . . . . . . . . 1
Definitions … ……………… …… … 2
Critical Care Team Composition and
Qualifications …….. ……… ……… 2
Crew Configurations ……………….. … 2
Educational Qualifications …………… … 2
Types of Critical Care Transport Professionals . . . 3
Modes of Transportation …………. …… … 3
Equipment. ……………….. ………. 3
Mobile Units … …….. …….. ………. 3
Rotor-Wing Aircraft … …………. …….. 4
Fixed-Wing Aircraft . . . . . . . . . . . . . . . . . . . . . . . . 4
The Transport Process . . . . . . . . . . . . . . . . . . . . . . . . 5
Dispatch ……………… …. ………. 5
Transport Choreography . . . . . . . . . . . . . . . . . . . 5
Transporting by Ground Versus Air . . ……… 5
Medical Oversight. . . . . . . . . . . . . . . . . . . . . . . . . 6
State and National Standards …………… … 7
Reimbursement …………… … ……….. 7
Well-Being ……………. …………….. 7
Stress … ………….. ………. …….. 7
Safety ……. ………. …….. ………. 8
Interpersonal Communication . . . . . . . . . . . . . . . . . 9
Quality Assurance and Improvement ……… … 9
The History of Critical Care Transport . . . . . . . . . . 10
Ground Transport . . . . . . . . . . . . . . . . . . . . . . . . 10
Air Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Summary …………………… ……… 13
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Prep Kit ………….. …. …………….. 15
CHAPTER 2 Medical-Legal Issues 18
Welcome to the Legal World . . . . . . . . . . . . . . . . . . 18
Emergency Medical Treatment and
Active Labor Act …… ………. ……. 18
Obligations, Duties, and Accountability
ofCCTPs ………… …………….. 19
Consequences of Violating EMTALA ……… 19
EMTALA and the CCTP: Case Scenarios …… 20
Legal Implications and Constraints for CCTPs … 21
Dealing With the Threat of Litigation . . . . . . . . 21
Key Responsibilities of CCTPs …… …….. 22
Patients’ Rights ……… …………. ……. 22
The Right to Establish Advance Directives …. 22
The Right to Say No (Refuse Treatment or
Transport) ……….. ………. ……. 22
The Right to Consent …….. …………. 23
The Right to Appropriate Care and the
Concept of Negligence ……………… 24
The Right to Confidentiality and the
HIPM Privacy Rule ……………….. 24
Legal Issues Related to Transport
Preparation …….. ………………. 26
Communication With the Health
Care Team ………………………. 26
Transfer Preparation …………. ……… 26
Documentation and Medical Records …….. 27
Patient Assessment ………………….. 27
Transport Responsibilities ………. ………. 27
Medical Direction ………. …….. …… 27
Personnel Qualifications …….. ………. 28
Actions During Transport . …….. ……… 28
Transport Completion ……………….. 28
Documentation ………………. ……… 29
Summary ……. ……… ……. ………. 30
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Prep Kit. ………… ….. ……. ………. 31
CHAPTER 3 Patient Safety 34
History of Quality as a Health Care Discipline …. 34
Scope of the Problem …… …………… 34
Quality of EMS Care ……. …………… 35
What Is Patient Safety? …………………. 35
Error Versus Harm …….. ……………. 35
Near Miss/Close Call ….. ……………. 36
Medical Errors . . ……………….. ….. 36
Safety Culture …….. …… …………… 36
Just Culture …………. . . ………….. 37
Highly Reliable Organizations … …….. … 3 7
Types of Errors Commonly Occurring in
Health Care …….. ….. ………….. 38
Medication and Prescription Errors ….. ….. 38
Wrong Patient Identification/Wrong-Side
Procedures …………. ………….. 39
Errors During Transitions of Care and
Handoffs …….. ….. ……………. 39
Why Do Health Care Errors Occur? ………… 39
Systems Approach ………………. ….. 3 9
Swiss Cheese Model ……. ………. ….. 39
Handling Serious Errors …… …………… 40
Strategies to Avoid Errors … …………….. 41
Six Sigma …………… ……………. 41
Lean ………………. ……………. 42
Crew Resource Management ………. ….. 42
Simulation Training ……. ………. … .. 43
Failure Mode and Effect Analysis ………… 43
Quality in EMS Settings … ………. …….. 43
Clinical Judgment …… ……………… 43
Error Reporting …………………….. 43
Communications …………………… 43
Vehicle and Provider Safety . . ………….. 44
Air Transport Safety …………………. 45
Interfacility Transport ………………… 45
Mitigation Strategies for Adverse Events
During Interfacility Transport ………… 45
Summary …………………………… 45
Case Study ……………… ………….. 4 7
Prep Kit …………………………….. 48
CHAPTER 4 Aircraft Fundamentals and
Flight Physiology 52
Introduction ………. ………………… 52
The Air Medical Role ………. ………….. 53
The Atmosphere …………….. ……….. 53
Atmospheric Composition …………….. 53
Layers of the Atmosphere ……………… 54
Physiologic Zones of the Atmosphere …….. 54
Barometric Pressure …………………. 55
Gas Laws … ……. ………….. ………. 55
Boyle’s Law ….. …………………… 55
Charles’s Law … ……………………. 55
Dalton’s Law … ……………………. 55
Fick’s Law ………… ………………. 56
Henry’s Law ……… ……………….. 56
Universal Gas Law ….. ………………. 56
Gay-Lussac’s Law ……………………. 56
Graham’s Law ……………………… 5 7
Formulas Based on the Eight Gas Laws ……. 57
Medical Transport Aircraft ………………. 57
Rotor-WingTransport ………………… 57
Fixed-Wing Transport ………………… 58
Pressurized Versus Nonpressurized Aircraft …. 58
The Air Medical Crew ………………….. 59
Air Medical Crew Configuration ………… 59
Primary Stressors of Flight ………………. 59
Decreased Levels of Po2 ••••••••••• •••• •••• 59
Barometric Pressure Changes …………… 59
Thermal Changes ………….. ………. 60
Vibration …………………………. 60
Decreased Humidity …………………. 60
Noise …………… ………………. 61
Fatigue …………………………… 61
Gravitational Forces …………………. 62
Spatial Disorientation and Illusions of Flight … 62
Third Spacing ……………………… 63
Flicker Vertigo …………. ………….. 63
Fuel Vapors ……………………….. 64
Weather …… …………………….. 64
Anxiety ……… ………. ………….. 64
Night Flying ……………………….. 64
Factors Affecting Tolerance of the Physiologic
Stressors of Flight . . . . . . . . . . . . . . . . . . . . . . 64
Illness ……… ……………………. 65
Medications ……………………….. 65
Stress ……………………………. 65
Alcohol ………………….. ……… 65
Fatigue …………. ……………….. 65
Emotion ………………………….. 65
Tobacco ………………………….. 65
Hypoglycemia ……………………… 66
Additional Stressors …………………. 66
Hypoxia ……………… ……………. 66
Effective Performance Time and Time of
Useful Consciousness ……………… 66
Types of Hypoxia …………………… 67
Four Stages of Hypoxia As They Relate to
Altitude ………………………… 68
Hyperventilation Versus Hypoxia ……….. 69
Recognition and Treatment of AltitudeInduced Hypoxia . . . . . . . . . . . . . . . . . . . . . . 70
Supplemental Oxygen Requirements …….. 70
Dysbarism and Evolved Gas Disorders ……… 70
Barotitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Barosinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Barodontalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Decompression Sickness . . . . . . . . . . . . . . . . . . 71
Operational Issues Related to Medical
Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Communications …………………… 72
Instrument Flight Rules Versus Visual
Flight Rules ……………………… 72
Initiating a Flight and Flight Following ……. 73
Identifying Flight and Scene Locations ……. 73
Air Medical Safety ………. ……………. 73
Air Medical Crashes . . . . . . . . . . . . . . . . . . . . . . 7 4
Causes of Air Medical Crashes . . . . . . . . . . . . . . 7 4
Making the Industry Safer. ………………. 75
Crew Resource Management …………… 75
Federal Aviation Administration Guidelines … 76
Weather-Related Issues ……………….. 76
Crew Safety Precautions ….. ………….. 77
Summary ……………. …………….. 77
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 8
Prep Kit ……………………………. 79
CHAPTER 5 Patient Assessment 86
Introduction …………………………. 86
Patient Assessment in the Critical Care
Environment …………………….. 86
Forming a Diagnosis and Treatment Plan ….. 86
Bridging Environments and Disciplines …… 87
Scene Versus InterfacilityTransport ………… 87
Scene Transport …………………….. 87
InterfacilityTransport …. …….. ……… 87
Arrival at the Transferring Facility ………….. 88
Obtaining a Patient History ……………… 88
The Hospital Patient Care Record … …….. 88
Differing Assessment Models ……… …… 92
The Bedside Assessment ………………… 92
Assessment of General Appearance ………. 92
Cardiovascular Assessment ……….. …… 92
Respiratory Assessment ……. …… ……. 95
Neurologic Assessment …… ………….. 97
Gastrointestinal Assessment. ……… …… 99
Genitourinary Assessment . . . . . . . . . . . . . . . . 100
Musculoskeletal Assessment. . . . . . . . . . . . . . . 101
Psychosocial and Emotional Assessment . . . . 101
Packaging for Transport . . . . . . . . . . . . . . . . . . . . 101
Reassessment During Transport . . . . . . . . . . . . . . 103
Patient Handoff and Documentation . . . . . . . . . 104
Summary ………………………….. 104
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Prep Kit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
CHAPTER 6 Respiratory Emergencies,
Airway Management, and Ventilation 1 1 0
Introduction ……. ………….. ………. 110
Anatomy and Physiology of the Respiratory
System …………………………. 111
Upper Airway Structures ………………. 111
Lower Airway Structures ….. …………. 112
Pediatric Considerations …………….. 113
Physiology of the Respiratory System. . . . . . . . . . 114
Respiratory Volumes and Capacities . . . . . . . . 116
Pathophysiology: Obstructive and
Restrictive Disease States . . . . . . . . . . . . . . . 117
Patient Assessment . . . . . . . . . . . . . . . . . . . . . . . . 117
Breath Sound Assessment Techniques. . . . . . . 117
Auscultation …. …………… …….. 119
Normal and Abnormal Respiratory Patterns . . . 119
Palpation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Assessment in Preparation for Transport ….. 121
ABG Monitoring …………………….. 122
Respiratory and Ventilation Abnormalities ….. 123
Basic Airway Management ……………… 124
Positioning ………………………. 124
Airway Adjuncts …….. ……………. 124
Suction ……………. ……………. 125
Oxygen Administration … …………… 126
Advanced Airway Management. …. ………. 129
Predicting the Difficult Airway …. ……… 129
Intubation …………….. ………… 130
Laryngeal Mask Airway . . . . . . . . . . . . . . . . . . . 144
King Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Surgical Airways . . . . . . . . . . . . . . . . . . . . . . . . 148
Pharmacologic Agents Used in Rapid
Sequence Intubation …….. … ……. 157
Sedative/Induction Agents ……. ……… 157
Neuromuscular Blocking Agents ……….. 157
Tracheostomy Management …………….. 157
Mechanical Ventilation …… …………… 160
Negative Pressure Ventilators ………….. 161
Positive Pressure Ventilators …………… 161
Invasive Versus Noninvasive Ventilation ….. 162
High-Flow Nasal Cannula ……………. 162
Ventilator Modes and Parameters . . . . . . . . . . 163
Positive End-Expiratory Pressure ……….. 163
Nitric Oxide ……….. …………….. 163
Ventilator Management ……………… 166
Troubleshooting ……… …………… 173
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 4
Case Study ………… ………………. 175
Prep Kit … ……………… …………. 176
CHAPTER 7 Critical Care Pharmacology 1 82
Introduction ………………………… 182
Pharmacology and Medication Information …. 182
A Practical Approach to Medication
Administration ………………….. 182
Pharmacokinetics . . . . . . . . . . . . . . . . . . . . . . . . . 183
Absorption ……… ………………. 183
Distribution ….. ………………….. 184
Biotransformation . . . . . . . . . . . . . . . . . . . . . . 184
Elimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Pharmacodynamics . . . . . . . . . . . . . . . . . . . . . . . . 184
Theories of Drug Action ……………… 184
Drug-Response Relationship ………….. 185
Factors Affecting Drug Responses ………. 185
Predictable Responses ….. …………… 187
Iatrogenic Responses …….. …………. 187
Unpredictable Responses …. ……… …. 188
Avoiding Medication Errors …. ……… …. 188
Medication Management …… …………. 189
Medication Storage ……. …………… 189
Security of Controlled Medications ……… 189
Specific Medications Used in Critical Care
Transport ………………………. 189
Vasopressors ………… …………… 189
Inotropes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Vasodilators and Antihypertensives ……… 194
Sedatives, Anesthetics, Analgesics, and
Anticonvulsants …………………. 197
Neuromuscular-Blocking Agents ……….. 207
Histamine Antagonists and Proton-Pump
Inhibitors ……….. …………….. 210
Antiemetic/Gastrointestinal Medications ….. 210
Pulmonary Medications … …………… 213
Antiarrhythmics ……… …………… 215
Anticoagulants and Thrombolytics ……… 219
Miscellaneous Medications . . . . . . . . . . . . . . . 221
Medication Infusion Technique ………….. 223
Summary ………………………….. 224
Case Study …………… ……………. 225
Prep Kit ……. ……………………… 226
CHAPTER 8 Laboratory Analysis and
Diagnostic Studies 232
Introduction ……. ……. ……… ……. 232
Principles of Analysis …. …. ………….. 232
Specimen Cultures …… … ……………. 234
Chemistry Review ………. …………… 234
Ions … ………… … ……………. 234
Osmolarity …………. … ………… 23 5
Biochemistry Review ……. ……… ……. 235
Lab Profiles ……. ……. ……………. 23 5
Lab Values in Blood Samples ………….. 23 5
Blood Components …… …………… 23 8
Proteins ………… … ……………. 23 9
Coagulation ………………………. 241
Osmolality …………. ……………. 242
Ethanol ………… … ……………. 242
Calculated Values ……… … ….. …… 242
Blood Gases …………… …………… 242
Acid-Base Status ………. ………….. 243
Oxygenation Status …………………. 243
Obtaining Blood Samples . . …………….. 244
Arterial Blood Samples . . …………….. 244
Venous Blood Samples …………. …… 246
Blood Tube Uses …….. ……………. 246
Point-of-Care Testing ……. ……………. 246
Regulation of Laboratory and
Point-of-Care Testing ……………… 24 7
Implications for Critical Care Transport
Professionals . . ……… ………….. 247
Urine Lab Values ……….. …………… 247
Color … …………. …………….. 247
Appearance … ……………………. 24 7
Specific Gravity …… … ……………. 24 7
pH ….. ……. ……. ……… ……. 248
Glucose ……. ………. ………….. 248
Ketone Bodies ……….. …………… 248
Protein … …………. ……………. 249
Blood and Hemoglobin …… ………… 249
Electrolytes ……… … ……………. 249
Diagnostic Imaging …….. ……… ……. 249
Standard Radiographs . . ……. ….. …… 249
Computed Tomography … …………… 249
Magnetic Resonance Imaging ………….. 250
Ultrasonography ……… … ………… 250
Summary … …………… … ….. …… 251
Case Study ………… … ……………. 253
Prep Kit …… ….. ……… ………….. 254
CHAPTER 9 Resuscitation, Shock, and
Blood Products 260
Introduction ……. ……. ……… ……. 260
Cellular Respiration ……… … ….. ……. 260
Microcirculation and the Cell: Oxygen
Transport and Utilization ………….. 262
Shock …………. ……….. ……….. 264
Initial Stage . . …. …… ………. …… 264
Compensatory Stage ……….. … ……. 264
Decompensatory Stage: Progressive Shock … 266
Refractory Stage: Irreversible Shock ……… 267
Multiple Organ Dysfunction Syndrome ….. 267
Classification of Shock ………………… 268
Cardiogenic Shock …… ………. …… 268
Hypovolemic Shock ………………… 271
Distributive Shock ……. …… … …… 273
Sepsis … ………. …. …. ………….. 275
Types of Sepsis ………. …………… 276
Epidemiology … …… …… ….. …… 2 77
Pathophysiology …………. ……….. 277
Assessment . . …. ……. …… … …… 2 79
Management ……. … ……….. …… 280
Blood Administration …….. …….. …… 283
ABO System ….. ………………….. 284
Blood Products … ……………. …… 285
Procedure ………. …………. …… 287
Transfusion Reactions ……………….. 289
Blood Transfusion Management
Considerat
ions . . . . . . . . . . . . . . . . . . . . . . . 291
Flight Considerations …………. … …… 291
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Case Study ……… ……….. ……….. 292
Prep Kit ……. ….. ……. …… … …… 293
CHAPTER 10 Trauma 302
Advances in Trauma Care ………………. 302
Scenarios Involving Trauma Patients …….. 303
Morbidity and Mortality ……… … …… 303
Overview of Trauma … ……………….. 303
Newton’s Laws of Motion ……….. …… 303
Types of Trauma ………. …….. …… 304
Triage ……………….. …………… 304
START Triage …. ………… ……….. 305
JumpSTARTTriage for Pediatric Patients ….. 305
Trauma Scoring Systems ……………….. 306
Glasgow Coma Scale …….. ……. …… 306
Trauma Score … ….. …….. ….. …… 308
Revised Trauma Score ….. …………… 308
Abbreviated Injury Scale ……………… 309
Injury Severity Score ………… … …… 309
Trauma Injury Severity Score ………….. 309
Trauma Systems ……………. ……….. .310
Levels ofTrauma Care ……………….. 310
Classification of Trauma Patients ………… 310
Interfacility Transport Trauma Management …. .310
The Hypothermia-Acidosis-Coagulopathy Triad … 311
Hypothermia ….. ……………….. … 311
Acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Coagulopathy . . . . . . . . . . . . . . . . . . . . . . . . . . 312
Diagnostic Imaging for Trauma …….. …… 312
Standard Radiographs. . . . . . . . . . . . . . . . . . . . 312
Computed Tomography ……………… 312
Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . 312
Transthoracic Echocardiography and
Transesophageal Echocardiography . . . . . . 314
Magnetic Resonance Imaging ………….. 314
Intra-abdominal Pressure Monitoring ……. 315
Transport Considerations …………….. 316
Thoracic Trauma ………….. ………… 316
Pneumothorax ……………………. 317
Hemothorax ……………………… 321
Management: Chest Tube Insertion ……… 323
Flail Chest …………….. ………… 327
Pericardia! Tamponade ………………. 329
Pericardia! Window ………………… 332
Aortic DissectionfTransection …………. 332
Myocardial Contusion ……. ………… 333
Diaphragmatic Rupture ……………… 333
Tracheobronchial Disruption ………….. 334
Pulmonary Contusion ………………. 334
Esophageal Perforation ………………. 335
Traumatic Asphyxia …………………. 335
Facial Trauma ………. ………………. 336
Ear Injuries ……………. ………… 336
Eye Injuries ……………. ………… 337
Mandibular Fracture and Dislocation ……. 339
Dental Avulsion …………………… 339
Neck Injuries …….. ………………… 339
Laryngotracheal injuries ……………… 340
Thyroid Injuries ………. …………… 341
Vascular Neck Injuries …….. ………… 341
Abdominal Trauma …………………… 341
Blunt Versus Penetrating Trauma ……….. 341
Challenges in Diagnosing Abdominal Trauma .. 342
Assessment ………….. ………….. 342
Management ……… ……….. ……. 342
Resuscitative Endovascular Balloon Occlusion
of the Aorta …………………….. 343
Hollow Versus Solid Organ Injury ………… 343
Spleen ……………….. ………… 344
Liver ……………………………. 345
Stomach …………………………. 345
Large and Small Intestines ……………. 345
Vascular Injuries ………… ………… 346
Pelvic Trauma ……… ………………. 34 7
Pelvic Fracture …………………….. 34 7
Open-Book Fractures …….. ………… 347
Extremity Trauma …….. …………….. 34 7
Musculoskeletal Injuries ….. …………. 34 7
Fractures ………………………… 348
Compartment Syndrome …………….. 350
Rhabdomyolysis and Crush Syndrome …… 350
Pulseless Extremity ……… …………. 352
Trauma to Special Populations …………… 352
Geriatric Trauma …………………… 352
Trauma During Pregnancy ……………. 352
Flight Considerations …………………. 353
Summary ………… ……………….. 353
Case Study … ………………………. 354
Prep Kit ……………………………. 355
CHAPTER 11 Neurologic Emergencies 363
Introduction …. ………… ………….. 363
Anatomy and Physiology …… …………. 363
Nervous System Organization …………. 363
Central Nervous System ……………… 364
Anatomy and Physiology of the Brain ……. 367
Cerebral Circulation . . . . . . . . . . . . . . . . . . . . . 3 71
Anatomy and Physiology of the Spinal Cord … 3 73
Peripheral Nervous System ……………. 374
Neurologic Examination ….. …………… 376
Mental and Emotional Status ………….. 376
Speech Function ……… …………… 378
Assessment of Cranial Nerves …………. 378
Assessment of Motor Function ……… … 385
Assessment of Sensory Function ……….. 385
Reflex Testing ……. ….. …………… 386
Evaluation of Meningeal Irritation ……… 387
Lhermitte Phenomenon … …………… 387
Vital Signs ………….. …………… 387
Neurologic Diagnostics … …………… 389
Laboratory Assessment …. …………… 390
Traumatic Brain Injury ….. ………. …… 390
Primary Brain Injury …….. ……… …. 390
Secondary Brain Injury …. ……….. …. 391
Specific Neurologic Injuries …………….. 392
Scalp Injuries ………… …………… 392
Skull Fractures ……. ………………. 392
Facial Fractures …. ………………… 394
Brain Injuries ……………………… 394
Intracranial Pressure . . ………………… 398
Physiology ……………. …………. 398
Cerebral Blood Flow ………………… 398
Cerebral Perfusion Pressure …………… 399
Pathophysiology of Increased Intracranial
Pressure ……………………….. 400
Clinical Manifestations of Increased ICP …. 400
ICP Monitoring ………. …………… 400
Multimodality Monitoring ……………. 405
Treatment Options for Increased ICP ……. 406
Brain Herniation ………. ……………. 408
Spinal Cord Injuries …….. …………… 409
Mechanism of Injury ……………….. 409
Primary Versus Secondary Spinal Cord
Injury ……………… …………. 410
Complete Versus Incomplete Spinal Cord
Injury …………… ……………. 410
Spinal and Neurogenic Shock …………. .411
Assessment of SCI …….. …………… .411
Management of SCI ….. ……………. 412
Complications of SCI . …. …………… 413
Stroke …………………. . …. . ……. 414
Mechanism oflnjwy … . ……………. 414
Types of Stroke . . . . . . . . . . . . . . . . . . . . . . . . . 414
Side Effects of Stroke. . . . . . . . . . . . . . . . . . . . . 414
Assessment of Stroke …….. ………… 414
Management of Stroke ………….. ….. 414
Intracerebral Hemorrhage . . ….. ………… 41 6
Subarachnoid Hemorrhage ……………… 41 6
Assessment of Subarachnoid Hemorrhage … 41 7
Management of Subarachnoid
Hemorrhage ………… …………. 41 7
Acute Guillain-Barre Syndrome ………….. 41 7
Seizures and Epilepsy …………………. 41 7
Transport Considerations ………………. 41 8
Prior to Transport . . . . . . . . . . . . . . . . . . . . . . . 41 8
Scene and Interhospital Transport
Considerations ……….. ………… 41 8
Flight Considerations … ………… ….. 41 9
Summary … …….. ………………… 41 9
Case Study ………… ….. ………….. 420
Prep Kit ……………….. … ……….. 421
CHAPTER 12 Bu rns 433
Introduction … … …….. ……………. 433
Anatomy and Function of the Skin ……….. 434
The Epidermis …………. …………. 434
The Dermis ………….. ………….. 434
The Process of Healing …. …………… 43 5
Functions of the Skin …………. ……. 43 5
Physiology of Bums …………………… 43 5
Causes of Bums … …. . …………….. 43 5
Anatomy of a Bum ……. …………… 43 5
Systemic Inflammatory Response of the
Burned Patient …….. …………… 43 5
Classification of Bum Injuries …….. ……. 43 6
Bum Extent and Depth ………………. 43 6
Bum Size ……. ……. ……………. 43 6
Bum Severity ………… …… ……… 43 8
Criteria for Referral to a Bum Center. ……. 43 8
Assessment ……………… …………. 43 9
Airway ……………………. ……. 43 9
Breathing …………… … ………… 440
Circulation ……… … ……………. 440
Management ………. ………………. 441
Stopping the Bum ……… ………….. 441
Circulation …………. ……. …….. 443
Wound Management and Dressings …….. 443
Wound Infections and Treatment ………. 444
Pain Control … …………… … …… 444
Other Issues ……… … ……………. 445
Special Situations …… … ……………. 445
Renal Failure and Rhabdomyolysis ……… 445
Ocular Bums … …….. ……… ……. 445
Facial Bums …………. … ………… 446
Ear Burns ………………………… 446
Circumferential Bums and Compartment
Syndrome ………… ………… … 446
Hand and Foot Bums …………….. … 44 7
Genitalia Bums ………….. ……….. 448
Pediatric Bums and Child Abuse …….. … 448
Electrical Bums ……….. ………….. 448
Chemical B ums ………………. …… 450
Hydrocarbon Bums …………. …….. 450
Stevens-Johnson Syndrome and Toxic
Epidermal Necrolysis Syndrome ……… 451
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451
Case Study …… ………………. … … 452
Prep Kit …………….. …………….. 453
CHAPTER 13 Electrophysiology, Cardiac
Devices, and Transport Management 457
Introduction …… …………. ….. …… 45 8
Cardiac Anatomy and Physiology ………… 458
The Heart ……….. …………. …… 45 8
The Blood Vessels . . . . . . . . . . . . . . . . . . . . . . . 461
Functioning of the Pump …………….. 462
The Electrical Conduction System of the
Heart …….. ………….. … …… 462
Cardiac Monitoring: 12-Lead ECG ………… 464
Monitoring Versus Assessment …………. 464
Lead Placement ….. … ……….. …… 464
Confirmation of Lead Placement ……….. 466
Recording the 12-Lead ECG …………… 467
Interpretation of the 12-Lead ECG … …… 467
Axis Determination ……… …………… 469
The Hexaxial System ………… … …… 469
Normal Versus Pathologic Measurements …. 471
Calculation of Axis Direction and Intensity . . . 4 71
Causes of Axis Deviations ………. …… 471
Bundle Branch Blocks and Hemiblocks …….. 4 72
Bundle Branch Blocks ….. …………… 472
Hemiblocks . . …. …… ………. …… 475
Bifascicular Blocks ……………. …… 476
Trifascicular Blocks …………………. 478
Selected ECG Findings ………. ….. …… 478
Hyperacute T Waves ………. ….. …… 478
ST-Segment Elevation ….. …………… 4 79
Hypertrophy ….. ……….. ……….. 4 79
Pre-excitation Syndromes …… ……….. 482
Pericarditis …… … ……………….. 483
Long QT Syndrome …….. ………….. 483
Ventricular and Wide Complex Tachycardia … 484
Electrolyte Imbalances and Drug Effects ….. 485
Conditions That Mimic Myocardial Infarction .. 490
Cardiac Disease ….. ……………. …… 490
Coronary Artery Disease and Angina …….. 490
Myocardial Infarction …. ….. . . . . …. . .. 493
Cardiomyopathy …………. ……….. 506
Heart Failure ………… …… … …… 506
Pulmonary Edema …………………. 508
Cardiac Electrophysiology ………………. 509
Therapeutic Options for Patients With
Arrhythmias ……….. …………… 510
Pacemakers ………………….. …… 511
Pacemakers and the ECG . . . . . . . . . . . . . . . . . 517
Implantable Cardioverter-Defibrillators ….. 519
Transport Considerations ………………. 522
Preparation …….. …. ……………. 522
Transport-Related Issues …. ………….. 523
Flight Considerations … …………….. 523
Summary ………… …. ……………. 523
Case Study …………………………. 524
Prep Kit ………….. ……………….. 525
CHAPTER 14 Hemodynamic Monitoring
and Circulatory Support _____
537
Introduction ……. …………… …….. 537
Cardiovascular Anatomy and Physiology …… 538
Cardiac Cyde ……………………… 539
Cardiac Output ….. ……………….. 540
Heart Rate ……………………….. 541
Prcload …….. ………………….. 542
Afterload ………. ……………….. 543
Contractility ……… ……………… 544
Blood Pressure ……………………. 545
Arterial Lines ……………………….. 545
Indications ………………………. 545
Contraindications ………………….. 546
Complications ……………… …….. 546
Arterial Line Placement ……………… 546
Obtaining Invasive Hemodynamic
Measurements ……… ………….. 548
Asepsis ………….. ……………… 551
Central Venous Lines ………………….. 551
Indications …. …… ……………… 552
Contraindications ………………….. 552
Complications …………………….. 552
Types of Central Venous Catheters ……… 552
Central Venous Catheter Placement …….. 554
Pulmonary Artery Catheters …………….. 556
Indications ………………. ……… 559
Contraindications ………………….. 559
Pulmonary Artery Catheter Placement …… 559
Invasive Pressure Measurements ………….. 560
Measurements From an Arterial Llne ……. 561
Measurements From a Central Venous Line … 563
Additional Measurements From a
Pulmonary Artery Catheter …………. 564
Pulmonary Vascular Resistance ………… 567
Systemic Vascular Resistance ………….. 567
Stroke Volume …………………….. 567
Mixed Venous Oxygen Saturation ………. 567
Heart Failure ………………… …….. 568
Intra-aortic Balloon Pump …….. ………. 568
Mechanics of IABP Function ………….. 569
Physiologic Effects of IABP Therapy …….. 570
Balloon Volume or Augmentation ………. 570
Waveform Changes and Triggers ……….. 570
Evaluation of an IABP Waveform … …….. 572
Evaluation of IABP Timing ……………. 573
IAB Insertion ………… …………… 575
Patient Assessment ……. …………… 580
Transport Considerations …………….. 581
Circulatory-Support Devices …………….. 582
Continuous-Flow Pumps ………. … …. 582
Extracorporeal Membrane Oxygenation ….. 585
Ventricular-Assist Devices …………….. 586
Total Artificial Heart ………………… 588
Potential Complications During Transport ….. 588
Complications Related to Hemodynamic
Monitoring …………………….. 588
Complications Related to IABP Therapy ….. 590
Shock …………………………… 592
Flight Considerations …………………. 593
Effects of Altitude Changes on
Hemodynamic Monitoring …………. 593
Effects of Altitude Changes on IABP
Therapy ……………………….. 593
Summary …. ………………………. 594
Case Study ………. ………………… 594
Prep Kit. …………………………… 595
CHAPTER 15 Gastrointestinal and
Genitourinary Emergencies 606
Introduction …………… …………… 606
Anatomy and Physiology …… …………. 606
Gastrointestinal System … …………… 607
Genitourinary System. . . . . . . . . . . . . . . . . . . . 610
Conditions Affecting the Alimentary Canal. …. 615
Epidemiology and Pathophysiology …….. 615
Assessment ……….. …………….. 620
Management ……………………… 623
Intestinal Obstructions ………………… 625
Epidemiology and Pathophysiology …….. 625
Assessment ………………………. 627
Management ……………………… 628
In-Flight Considerations for Intestinal
Obstructions ……………………. 631
Liver Disease ……………. …………. 631
Epidemiology and Pathophysiology …….. 631
Assessment ………………………. 632
Management ……………………… 633
Biliary Tract Obstructions ………………. 634
Epidemiology and Pathophysiology …….. 634
Assessment ………………………. 634
Management ……………………… 635
Pancreatic Disease ……………………. 635
Epidemiology and Pathophysiology …….. 635
Assessment ……….. …………….. 636
Management ……………………… 637
Urinary System Conditions . ….. ………… 638
Acute Kidney Injury ………………… 638
Chronic Kidney Disease …. ………….. 640
Urinary Tract Infections ……………… 642
Testicular Torsion ………………….. 643
Penile Fracture ….. ………………… 643
Priapism …… … ……… ………… 643
Maintenance Tubes . . …………………. 643
Feeding Tubes ….. ….. ….. ….. …… 643
Drainage Tubes …. ………………… 645
In-Flight Considerations for Maintenance
Tubes …… …. ……… ………… 650
Metabolic Regulation of Add-Base Status …… 650
Acid-Base Physiology … …………….. 650
Intrinsic Regulation of Acid-Base
Balance ……….. ……………… 651
Metabolic Alkalosis …………………. 654
Metabolic Acidosis ………. ………… 654
Flight Considerations …………………. 655
Summary ………. …………………. 656
Case Study ………… ….. ………….. 656
Prep Kit ………….. ……………….. 658
CHAPTER 16 Endocrine Emergencies 666
Introduction ….. ……. ……….. ……. 666
Anatomy and Physiology ……. ………… 666
Thyroid ………… … ……………. 666
Parathyroid Glands …… ……………. 666
Adrenal Glands . . ……… ………….. 668
Aldosterone ……… … ……………. 668
Pancreas …………………… ……. 668
Diabetes … ………………………… 669
Pathophysiology ………. ………….. 669
Assessment …………. …………… 671
Management …………. ………….. 672
Pituitary Disorders …… … ……………. 673
Pathophysiology …………….. ……. 673
Assessment … ….. ……………….. 674
Management . ………. ……… ……. 674
Adrenal Abnormalities ……. ………….. 674
Pathophysiology ………. …….. …… 674
Assessment ……… … ……………. 677
Management … …….. ……… ……. 678
Thyroid Abnormalities …… ……… …… 678
Pathophysiology ………. ………….. 678
Assessment ……… … ……………. 679
Management … …….. ……………. 680
Lipid Disorders … …….. ……………. 681
Antiphospholipid Syndrome ………….. 681
Metabolic Syndrome ………….. ……. 681
Flight Considerations …. …. ………….. 681
Summary ……………. ……………. 681
Case Study ………… … ……………. 681
Prep Kit ……. …. ……… ………….. 683
CHAPTER 17 Environmental Emergencies 688
Introduction …………… …………… 688
Risk Factors ……. ………………… 688
Thermoregulation …… …… ….. …… 688
Basal Metabolic Rate ……….. … ……. 690
Heat Transfer ……………. ….. …… 690
Expecting the Unexpected ………. …… 690
Heat Emergencies ………. …… … …… 690
Risk Factors ….. …… …… ….. …… 690
Heat Cramps ……………. ….. …… 692
Heat Syncope ……. ………………. 693
Heat Exhaustion ….. …. …… … …… 693
Heatstroke …… …… …… ….. …… 694
Expecting the Unexpected ………. …… 696
Cold Emergencies … ……………. …… 696
Frostbite … …. …………… … …… 696
Hypothermia ….. ……….. ……….. 698
Expecting the Unexpected ………. …… 699
Drowning ……… ………….. … …… 699
Treatment …… …… ……….. …… 699
Diving Injuries and Decompression Sickness … 699
Treatment ….. …………… … …… 700
Hyperbaric Oxygen Therapy …………… 700
Flight Considerations . . . . . . . . . . . . . . . . . . . . 701
Altitude Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . 701
High-Altitude Pulmonary Edema ………. 701
High-Altitude Cerebral Edema ……. …… 702
Flight Considerations … ……….. …… 702
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
Prep Kit ……….. ………….. … …… 704
CHAPTER 18 Infectious and
Communica ble Diseases 709
Introduction ……….. …………. …… 709
Fundamental Principles of Infectious
Disease ……. ………. ………….. 710
Complexity of the Spread of Disease ……… 710
Classification … ….. …………. ……. 710
The Human Immune System ………. …… 712
Types of lmmunity ……………. …… 712
Antigens …….. …… …… ….. …… 71 3
Organs and Cells of the Immune System …. 71 3
Humoral Immunity ……. ………….. 714
Cell-Mediated Immunity ……….. …… 714
Hypersensitivity Reactions . . . . . . . . . . . . . . . . 71 5
Immunodeficiency …….. …….. …… 71 6
Immunosuppression: Transplant Patients …. 71 6
Pathogenicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 7
Normal Bacteria ………. ………….. 71 7
Opportunistic Bacteria . . . . . . . . . . . . . . . . . . . 71 7
Pathogenic Bacteria …………………. 71 7
Virulence Factors …………………… 71 7
Viral Pathogenicity ……………. …… 71 8
Epidemiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Reservoirs oflnfection . . . . . . . . . . . . . . . . . . . 721
Modes of Transmission ……………… 721
Selected Diseases ………….. ………… 722
Meningitis ……….. ….. …………. 722
Respiratory Syncytial Virus ……………. 724
Neaotizing Fasciitis ………………… 724
Epiglottitis ………… …………….. 725
Tuberculosis …. ………………….. 726
Pneumonia ………………………. 728
Fungal Diseases ……………………. 729
Influenza ………………………… 729
Herpesviruses …………………….. 730
Viral Hepatitis ………….. ………… 731
Human Immunodeficiency Virus ………. 734
Rickettsial Diseases ………. ………… 737
Emerging Infectious Diseases ……………. 738
Severe Acute Respiratory Syndrome ……… 738
Escherichia coli O157:H7 ……………… 741
West Nile Virus …….. ….. ………… 741
Strategies for the Treatment of Infectious
Disease ……………………….. 742
Antibiotics …….. ………………… 743
Antivirals ………………………… 7 43
The Post-Antibiotic Era ………………… 743
Antibiotic Resistance ………………… 744
Methicillin-Resistant Staphylococcus
aureus …………………………. 744
Vancomycin-Resistant Enterococci ………. 745
Bioterrorism ………………………… 745
Exposure and Protection ……………….. 746
Immunizations ……………………. 7 46
Needlestick Injuries ……… ………… 747
Universal, Standard, and TransmissionBased Precautions ………………… 747
Isolation Precautions ……………….. 747
Handwashing …………………….. 748
Personal Protective Equipment ………… 750
Other Exposure Prevention Practices …….. 7 50
Work Practice Controls ……. ………… 751
Post-Exposure Risks and Protocols ……… 752
Flight Considerations …………………. 753
Summary ……… ………………….. 754
Case Study …………………………. 754
Prep Kit ……………………………. 7 5 6
CHAPTER 19 Toxicologic Emergencies 768
Introduction ………………………… 768
General Toxicologic Emergency Management … 769
Assessment …….. ….. …………… 769
Laboratory Assessment. … …………… 77 4
Toxic Syndromes and Medication Reaction
Syndromes …………………….. 77 4
Toxic Syndromes (Toxidromes) ….. ……. 77 4
Medication Reaction Syndromes …. ……. 776
Decontamination ……………………. 776
Skin Decontamination …… …………. 777
Ocular Decontamination …………….. 777
Gastric Decontamination …………….. 777
Enhanced Elimination …… …………. 780
Specific Toxicologic Emergencies …………. 780
Pharmaceutical and Abuse Agents ………. 780
Chemical Agents ……… …………… 790
Highly Toxic Substances … …………… 798
Hazardous Materials Response …………… 798
CCTPs’ Role at Hazardous Materials
Scenes …………… …………… 798
Transport Considerations …. …………. 799
Radiation Emergencies …….. …………. 799
Flight Considerations …… ……………. 800
Summary ………………………….. 800
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801
Prep Kit ………………. …………… 802
CHAPTER 20 Obstetric and Gynecologic
Emergencies _________
808
Introduction ………………………… 808
Anatomy and Physiology of the Female
Reproductive System ……………… 809
Conception and Gestation ……………. 809
Physiologic Changes During Pregnancy. . . . . . . . 810
Cardiovascular System . . . . . . . . . . . . . . . . . . . 810
Respiratory System …………………. 812
Gastrointestinal System . . . . . . . . . . . . . . . . . . 812
Renal and Endocrine Systems . . . . . . . . . . . . . 813
Dermatologic Changes . . . . . . . . . . . . . . . . . . . 813
Critical Care Transport of the Pregnant Patient .. 813
Cardiac Arrest Management of the Pregnant
Patient. ……………………….. 813
Fetal Assessment and Monitoring …………. 814
Fetal Circulation, Oxygenation, and
Heart Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . 814
Fetal Assessment ……… …………… 815
Electronic Fetal Monitoring . . . . . . . . . . . . . . . 816
Complications of Pregnancy …………….. 821
Spontaneous Abortion . . . . . . . . . . . . . . . . . . . 821
Ectopic Pregnancy …….. …………… 821
Bleeding ……………… …………. 822
Medical Conditions During Pregnancy …….. 824
Hypertension During Pregnancy ……….. 824
Preedampsia and Edampsia ………….. 825
HELLP Syndrome … ….. …………… 826
Complications During Labor ……………. 826
Transition of Fetal Circulation at Birth …… 826
Preterm Labor ……….. …………… 826
Prolonged Pregnancy ….. ……….. …. 827
Delivery ……… …………………… 828
Malpresentations … ….. …………… 828
Umbilical Cord Prolapse …. …………. 830
Shoulder Dystocia …….. …………… 831
Multiple Births ……………………. 832
Postdelivery Care ………………….. 832
Postdelivery Complications …………….. 832
Postpartum Hemorrhage …………….. 832
Amniotic Fluid Embolism ……………. 833
Rh Incompatibility and Erythroblastosis
Fetalis ………………………… 833
Uterine Inversion ………………….. 833
Gynecologic Emergencies ……. ………… 834
Pelvic Inflammatory Disease ………….. 834
Toxic Shock Syndrome ………………. 834
Ovarian Cysts …………………….. 834
Ovarian Torsion …………………… 835
Gynecologic Trauma …… ……….. …… 836
Summary ……… ………………….. 836
Case Study …………………………. 83 7
Prep Kit …………. ………………… 839
CHAPTER 21 Neonatal Emergencies 843
Neurologic Conditions ………………… 875
Introduction ………… ……………… 844
Anatomy and Physiology of a Neonate …….. 844
Thermoregulation ………………….. 844
Respiratory Structure and Function ……… 845
Oxygen Transport ………………….. 845
Cardiovascular Function ……….. ……. 845
Transitional Circulation ……………… 846
Renal Function ……………………. 84 7
Fluid and Electrolyte Balance ………….. 847
Central Nervous System, Nociception, and
the Stress Response ……………….. 847
Developmental Aspects of Pain ………… 84 7
Skeletal Development ……………….. 84 7
Neonatal Assessment and Stabilization …….. 847
Risk Factors for Neonates …………….. 847

Persistent Pulmonary Hypertension …….. 866
Shock …….. ……………………. 867
Anemia …………………………. 869
Gastrointestinal Conditions …………….. 869
Abdominal Wall Defects ……………… 869
Gastrointestinal Obstruction and Vomiting … 870
Acute Intestinal Perforation …………… 872
Intussusception ………….. ……….. 873
Diarrhea …………………………. 873
Infectious Diseases/Sepsis ………………. 873
Hyperthermia/Hypothermia …………….. 873
Toxic Exposure ………… …….. …….. 873
Trauma/Birth Injuries ….. ……….. …… 874
Head and Neck Injuries ……………… 87 4
Nerve Injuries …………………….. 874
Bone and Other Injuries ……………… 874
Abuse/Maltreatment. ……………….. 875

Seizures …………………………. 875
Hypoxic Ischemic Encephalopathy ……… 875
Lethargy …………… ……………. 876
Metabolic Conditions …………………. 876
Metabolic Acidosis …………………. 876
Hypoglycemia …………….. ……… 876
Hypocalcemia …………………….. 876
Inborn Errors of Metabolism ………….. 876
The Transfer Process for a Neonate ……….. 877
Using an Incubator …………………. 877
Family Communication and Support ……. 878
Flight Considerations ………. ………… 878
Summary ….. ……………………… 879
Case Study … ………………………. 879
Prep Kit ………………… …………. 880
Cord Clamping ……………………. 848 CHAPTER 22 Pediatric Emergencies 887
Apgar Score ………………………. 848
Laboratory Assessment . ……………… 848 Introduction ………………………… 887
Stabilization and Management ………… 848 Anatomy and Physiology …… …………. 887
Neonatal Resuscitation ………………… 849 Cardiovascular System ………………. 887
Primary Assessment: Airway, Breathing, Respiratory System ……. …………… 888
and Circulation …………………. 850 Neurologic System ….. …………. …. 888
Airway and Breathing Management ……… 850 Musculoskeletal System ……………… 889
Circulation ………………………. 856 Gastrointestinal System ……………… 890
Pharmacologic Interventions ………….. 857 Renal System ……………………… 890
Ventilation During Transport ………….. 861 Thermoregulation ………… ……….. 890
Additional Transport Considerations ……. 861 Metabolism ……….. …………….. 890
Respiratory Conditions ………………… 861 Glucose Requirements ………………. 890
Apnea …………………………… 862 Growth and Development ……………… 890
Causes of Respiratory Distress in a Neonate … 862 Physical Growth and Development ……… 890
Management of Respiratory Distress and Psychosocial Growth and Development ….. 891
Failure ………………………… 864 Approach to Parents and Caregivers ……….. 891
Cardiovascular Conditions ……………… 865 Pediatric Assessment …….. …………… 891
Cyanosis ………………………… 865 History ………………………….. 892
Cyanotic Congenital Heart Disease ……… 865 Pediatric Medication Delivery …………. 893
Tachyarrhythmias and Bradyarrhythmias …. 866 Airway ……. ……………………. 894
Breathing ……………. …. ………. 895
Circulation ………………………. 896
Neurologic Assessment … ……………. 897
Renal Assessment … ……………….. 898
Exposure Considerations ……… …….. 899
Transport Considerations ………. ….. …. 899
Equipment …………… …. ………. 899
Interfacility Transport Considerations ……. 899
Mode of Transport …. ……………… 900
Accompanying Parents and Caregivers …… 900
Airway Management Devices …….. …….. 900
Flow-Inflating Bag …. ………. ….. …. 900
Self-Inflating Bag …………… ….. …. 900
Oxygen Hood …………. ….. …….. 901
Shortened Tracheal Tube ….. ………… 901
Blade Options . . . . . . . . . . . . . . . . . . . . . . . . . . 901
Respiratory Conditions ……….. ………. 901
Croup ………………. ………. …. 902
Ep1glottrlls ……………….. ….. …. 903
Foreign Body Airway Obstruction ……. … 903
Inflammation …….. …… ………… 904
Asthma …………… …………….. 904
Bronchiolitis …. …………. ………. 905
Bronchopulmonary Dysplasia ….. …. …. 905
Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 907
Acute Respiratory Distress Syndrome ……. 907
Sudden Infant Death Syndrome and
Apparent Life-Threatening Events …. …. 908
Cardiac Conditions . . …………………. 908
Shock …………………………… 908
Cardiac Anomalies … ………. ….. ….. 910
Pediatric ECG Interpretation . . ………. … 911
Renal Conditions …………. ….. . . … …. 911
Prerenal Disorders … ………. ….. ….. 911
Intrarenal Disorders … ……………. … 911
Postrenal Disorders …………. ….. …. 914
Complications of Acute Renal Failure ……. 914
Meningococcal Infections … …. ………… 91 5
Trauma . . ………………. ………. … 91 5
Traumatic Brain Injury . . . . . . . . . . . . . . . . . . . 91 6
Spinal Cord Injuries … ……………… 91 9
Breathing Abnormalities …….. ….. …. 920
Abuse and Neglect …… … …….. …. …. 921
Hypothermia During Transport . . ………… 922
Drowning …….. ……….. …………. 9 22
Flight Considerations ……. …………… 923
Summary ……………. ……………. 923
Case Study ………. ……. ………. …. 923
Prep Kit ………………. …………… 925
CHAPTER 23 Bariatric a nd Special
Situations 932
Introduction …………… . . …………. 932
Bariatric Surgery Patients … … ………. …. 932
Types of Bariatric Surgery … …….. …… 933
Complications of Bariatric Surgery ……… 934
Oxygen Consumption ……… ………. 935
Dispatch Procedures ……. ………. …. 935
Moving Bariatric Surgery Patients ………. 937
Special Considerations with Bariatric
Surgery Patients ……. …… … …… 938
Reimbursement Issues …… …………. 939
Excited Delirium Syndrome …. …………. 939
Risk Factors …. ……………… …… 939
Pathophysiology ………. ………….. 940
Signs and Symptoms … … ………. …. 940
Treatment ….. …………………… 941
Interfacility Transport Monitoring ………. 942
Children With Special Health Care Needs …… 943
Congenital Heart Disease …………. …. 943
Hematology-Oncology Pediatric Patients …. 947
Pediatric Patients With Venous Access
Devices ……….. …. ………….. 948
Pediatric Patients With Respiratory
Disorders …………. …………… 948
Pediatric Patients With Neurologic
Disorders …….. …… ………….. 949
Pediatric Patients With Gastrointestinal
Disorders …….. . . ……. ….. …… 951
Special Considerations With Pediatric
Patients ……. ……… …………. 952
Summary …….. ……………… …… 952
Case Study … …………… …………. 953
Prep Kit. ……… ………. ………. …. 954
GLOSSARY 960
INDEX 994

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