top 10 ways to prepare for a pediatric critical care transport
TRANSCRIPT
574 JOURNAL OF EMERGENCY NURSING 29:6 December 2003
P E D I A T R I C U P D A T E
Top 10 Ways
To Prepare for a Pediatric Critical
Care Transport
Section Editor’s note
Often our most well-read articles result from the suggestions ofour readers. In this instance, readers have contacted us aboutpreparing an ill child for the arrival of the pediatric critical caretransport team. We solicited the following article as a result of thisrequest.
Preparing for a pediatric critical care transport
The top 10 ways to prepare for a pediatric critical caretransport are as follows:1. Airway: A transport team’s threshold is much lower for
securing an airway in any child who has the potentialfor decompensation during the transport. It is mucheasier to secure the airway in a controlled environmentwith the assistance of ED nurses, rather than in theback of a moving ambulance or helicopter. One exam-ple of this type of patient is a child with suspectedmeningococcemia. Such a child is managed with ag-gressive airway control as well as fluid resuscitationbecause he or she often decompensates so rapidly.
2. Intravenous access: Critically ill children require 2 large-bore patent intravenous lines. This is especially true forchildren who require transfusions or pressors or have thepotential for needing them during transport. Childrenwho are in diabetic ketoacidosis also should have asecond intravenous line for frequent blood drawing.
3. Sedation: Intubated children often are undersedated.Children usually metabolize sedatives more quicklythan do adults, and thus vital signs should be carefullytrended to ensure adequate sedation. Tachycardia withan increasing blood pressure may be signs of inadequatesedation in a paralyzed, intubated child.
Author: Robert Shields, RN, CEN, NREMT-P, Saugus, Mass
Section Editor: Deborah Parkman Henderson, RN, PhD
Robert Shields is Staff Nurse II, Critical Care Transport Team,Children’s Hospital, Boston, Mass.
For reprints, write: Robert Shields, RN, CEN, NREMT-P, 14 MortonAve, Saugus MA 01906; E-mail: [email protected].
J Emerg Nurs 2003;29:574-5.
Copyright © 2003 by the Emergency Nurses Association.
0099-1767/2003 $30.00 + 0
doi:10.1016/S009-1767(03)00347-7
December 2003 29:6 JOURNAL OF EMERGENCY NURSING 575
PEDIATRIC UPDATE/Shields
4. Spinal immobilization/splinting: All children withthe potential for a spinal injury should be immobilizedfor the transport. This remains true for patientswho have been cleared by radiographs because of the65% chance of spinal cord injury without radiographicabnormality.
5. Orogastric/nasogastric tube: Gastric decompressionis a must for all intubated children. Placement of anorogastric or nasogastric tube is also important in chil-dren with multisystem trauma, because a paralytic ileusis likely to develop in these children.
6. Charts: All paperwork, laboratory results, radiographs,and forms should be copied prior to or at the time ofthe team’s arrival. Do not forget that ConsolidatedOmnibus Reconciliation Act (COBRA) form!
7. Exposures: Any recent exposures to communicablediseases or special precaution needs for the child shouldbe verbalized to the transport team as soon as possiblefor obvious reasons, but also so that an appropriate bedassignment at the receiving facility can be made in atimely fashion.
8. Nursing flow sheet: Keeping a nursing flow sheet cur-rent is of utmost importance because this documenttypically is our best source of information about med-ications administered, patient response to treatments,and fluids administered.
9. Medications and equipment: Pediatric critical caretransport teams generally carry a supply of medicationsand equipment, but preparing and labeling additionalrounds of medications for the child may expedite careif they are offered to the team. The same is true of anydisposable equipment.
10. Thermoregulation: Remember that children losebody heat much more rapidly than do adults, and thusattention should be paid to keeping children warm.
Submissions to this column are welcomed and encouraged. Contri-butions can be sent to:
Deborah Parkman Henderson, RN, PhD1255 Linda Ridge Rd, Pasadena, CA 91103
310 328-0720 • [email protected]