Tamingthesru
Sepsis in the Air
Next to STEMI and neurologic emergencies such as spontaneous ICH, SAH, and ischemic stroke, one of the most common pathologies we transfer from one facility to another on Air Care is sepsis. However, unlike many of the other patients we transfer, these patient’s are usually being transferred from the ICU of an outlying facility to the ICU of a tertiary referral center that can deliver a higher intensity of care. I sat down and discussed with Dr. Bill Knight, a former flight MD and now Emergency Medicine and Neurocritical care physician, about some of the complexities of caring for these patients.
The Myth of the Stable STEMI Transfer
We fly/transfer many patients with STEMI on Air Care and Mobile Care. And, fortunately, a majority of these patients end up doing very well. You accept them at the referring facility, load them in the helicopter, and transfer them to the cath lab at the receiving facility without incident. You certainly may make some adjustments in nitro drips, maybe give some metoprolol, certainly review their outside hospital records, but usually the biggest benefit you are offering them is rapidity of transport. Transport 20 or 30 of these patients without incident and you might get lulled into thinking that these patients are so incredibly stable that nothing bad will happen during the course of the transport. To do so would be folly.
Running a Code (in Tight Quarters)
How many hands does it take to run a code? Think about that for a bit...
In the SRU, the available hands seem essentially limitless. There's a train of PCAs and medical students lined up to perform CPR, a nurse to run the monitor and defib, a nurse and/or pharmacist pulling up meds and mixing drips, a nurse charting, a MD dedicated to the airway, a RT to help with bagging, not to mention the MD running the whole show. At a minimum you probably have 10 hands ready to ensure compressions are as uninterrupted as possible, to keep a check on the respiratory rate, to hook up monitors, push meds, defib, and all the other tasks that are necessary to code a patient.
Now what do you do in the back of the helicopter when a patient loses a pulse?