Tamingthesru
Lessons in Transport - Surviving Sepsis
We routinely transport patients with severe sepsis and septic shock by both air and ground. Take a few moments to review these high yield management pearls from the 3rd edition of the Surviving Sepsis Campaign Guidelines.
Initial Resuscitation:
- Goals during the first 6 hours of resuscitation:
- CVP 8-12 mmHg (a debate on the utility of CVP or lack their of is beyond the scope of this LIT)
- MAP > 65 mmHg
- Urine output > 0.5ml/kg/hr
- Central venous or mixed venous oxygen saturation 70% or 65% respectively (grade 1c)
- In patients with elevated lacate levels we should target resuscitation to normalize lactate (grade 2c)
Multiple Helicopter Scenes
It is not uncommon for multiple helicopters to land on the scene of a multi-car accident or a single vehicle accident with multiple seriously injured victims. Assessing, caring for, and transporting multiple victims adds a significant amount of complexity to these scene flights. With multiple helicopters flying in, it is especially crucial that we heed all the lessons of crew resource management. Situational awareness both in the air and on the ground is key. But the challenges of multiple helicopter scenes are not limited only to safety considerations.
Lessons in Transport - Avoiding Medication Errors
It takes an estimated 80-200 correctly executed tasks to successfully administer a single dose of a medication to a critically ill patient...
Our reality in transport medicine... We routinely work in an environment that is prone to medical error. An environment that is...
- Dynamic and potentially dangerous
- Fast paced... where speed is perceived as excellence
- Limited in space, resources, and personnel
- Built on inferred indications with little access to confirmatory tests
- Frequent patient care hand offs of high acuity patients
- Defined by actions and inaction that have immediate consequences with little recovery time to stop sequential errors
- Not reproducible... No mission is ever the same