Prehospital and retrievals

Question 1

Describe Airway 2 study

Answer 1

Looking at optimal airway management during OOCHO

Multicentre cluster randomised trial
paramedics from 4 ambulance services in ENgland

No statistical difference in MRS score at hospital discharge or 30 days after OHCA

Nil difference in surival, regugitation, aspiration or ROSC

Difference in intial ventilation success with 87.4% in SGA compared to 79% in ETT

Question 2

Compare and contrast transport platforms

Answer 2

Road – good for short distance <50km/hr, nil concern over pressurisation or temperature

Rotatory- 75-175kg - door to door transfer where helipads exist at referral and estination, primary response capability, avoid multiple patient transferrs and road legs

Fixed wing - greater distances, can pressurise and control temperature, more space than rotatory

Question 3

Discuss environemental impacts on retrivals

Answer 3

Usually confined and limited in space
Care, deliberate planned actions and vigilance are important as is the need to ensure all equipement is secured

Altitude results in reduction in parital pressure of oxygen and expansions of gas wihtin enclosed spaces. Expansions of gas (undrained pneumo or in distended bowel) may result in pain or significant worsening of underlying pathology.

Question 4

Discuss recognition of extubation in transport

Answer 4

Recognition

• tube out
• sounds of air leak
• falling co2
• vent alarm - low MVe
• dropping sats

Differential

• isolated cuff leak
• circuit disconnection

Communications

• stop ambulance (consider urgent landing)
• notify pilot
• notify co-ordinator, Med ONE status

Action

• is isolated cuff leak (as long as o2 is ok) leave in
• rescure BVM
• attempt re-itubation
• Consider LMA or surgical airway

System

• secure ETT, circuit and ensure cuff working before moving
• controlled patient movements.