Chapter 13 - Transfer to Definitive Care

Question 1

Which patients require the highest level of care and will likely benefit from timely transfer

Answer 1

• evidence of shock

- progressive deterioration in GCS

Question 2

What AIRWAY concern would we transfer

Answer 2

-airway compromise
- high risk airway loss
Intubate at local facility first if able or monitor very closely

Question 3

what BREATHING issues suggest transfer

Answer 3

• tension pneumothorax
• haemothorax / open pneumothorax
• hypoxia / hypoventilation
  if needed prior to transfer intubate or chest drain or CXR then chest drain

Question 4

what CIRCULATION issues suggest transfer

Answer 4

• hypotension after reliable IV/IO access, control of external haemorrhage using pressure or tourniquets
• Pelvic fracture after X-ray and binder
• Vascular injury e.g. expanding haematoma or active bleeding after reliable access, IV fluids, control of haemorrhage
• Open fracture after reduce and splint and dress
• Abdo distension/ peritonitis after FAST

Question 5

what DISABILITY issues suggest transfer

Answer 5

GCS <13
Intoxicated patient who cannot be evaluated after sedation and intubation
evidence of paralysis after restriction of spinal motion and monitoring for neurogenic shock

Question 6

What issues on the secondary survey suggest transfer

Answer 6

• head and skull depressed fracture or penetrating injury after CT scan if they’re stable
• max fax injury e.g. eye injury, open fractures, complex lac, ongoing nasopharyngeal bleed after CT scan if stable

Question 7

why should elderly people be transferred formless severe injuries

Answer 7

because of their reduced physiological reserve and likely co-morbidities

Question 8

What is the job of the referring doctor

Answer 8

to initiate transfer of the patient, selecting mode of transport and level of acre required for optimal treatment en route