In Flight Patient Care Considerations for:

BurnsNeurologicalSpinal Cord

Objective

• Apply knowledge of flight physiology and aviation environmental stressors in the planning and delivery of pre-flight and in-flight care of patients with cardiopulmonary, gastrointestinal, genitourinary, neurological, ophthalmologic, otorhinolaryngologic, orthopedic, and burn injuries and conditions

General Considerations

• Preflight Mode of transportPatient AssessmentSuppliesEquipment

General Considerations

• IV flow rates without pump

• O2 conversion table – sea level equivalent

• Securing patient and equipment

• Securing self

• Reliance on low tech physical assessment

• Hearing protection for patient and ERC personnel

Burn Injuries

• Preflight Assessment%TBSA burned, location and sourceStatus of airway and patencyVascular accessFluid requirementsPatency of foley, NGVital signs, POX, urine output

Burn Injuries

• Preflight AssessmentPain medication, sedationPeripheral pulsesPresent wound managementAssociated injuries and need for altitude

restriction (CXR)Secure vascular access, ET tube with

sutures

Burn Injuries

• Preflight AssessmentAssess Hct and transfuse if < 30% prior to

flightIf MD orders topical cream, apply evenly

1/16 to 1/8 inch thick and cover with absorbent dressing and Kling

Burn Injuries

• Stresses of flightAll stresses of flight will affect the burn

victim Thermal Decreased partial pressure of oxygenDecreased barometric pressureDecreased humidity

Burn Injuries

• In-flight considerationsMonitor mental statusAdminister warmed, humidified oxygen –

exception for face, head, neck burnsElevate headContinue with fluid resuscitation- second 24

hours add colloids – 200ml salt poor albumin/800ml LR at 0.5ml/kg/%TBSA

Burn Injuries

• In-flight considerationsSecond 24 hours addition of dextrose to

meet metabolic demands – D51/4 NSMaintain urine output >50ml/hr(75-100ml

for electrical) monitor for myoglobinuriaNG to gravity or suction -monitorHourly evaluation of all peripheral pulses

Burn Injuries

• In-flight considerationsProtect from convection heat losses – shield

from drafts and airflowMaintain core body temperature 99-100Dressings should be occlusive, NEVER

change en routeMedicate frequently – use small doses

Morphine 2-4 mg IVP. Avoid Demerol

Neurological Injuries

• Preflight AssessmentDiagnosis, treatmentAirway, Mechanical ventilation settingsLOC, GCSPupil assessmentVital signsMotor, sensory evaluation

Neurological Injuries

• Preflight AssessmentDiagnosis, treatmentAirway, Mechanical ventilation settingsLOC, GCSPupil assessmentVital signsMotor, sensory eval

Neurological Injuries

• Preflight Assessment Seizure activity, medicationsIVF, NG, Foley and patency

Neurological Injuries

• Stresses of flightDecreased partial pressure of oxygenBarometric Pressure ChangesDecreased HumidityG-Forces

Neurological Injuries

• In-flight considerationsField-level altitude restriction for all

penetrating, PBI induced head injuriesMaintain POX>/=95%, tight ETCO2

control between 25-27(pCO2 30-32)Administer paralytics, sedation as neededAvoid succinylcholine use for RSI – IIP

Neurological Injuries

• In-flight Considerations IVF in absence of causes of hypovolemia at 80ml

NS/hr – maintain MAP 65-70Closely monitor GCS, pupils –for deterioration in

GCS or pupil changes evidencing IIP administer 20% Mannitol 1-1.5 g/kg bolus

Maintain normothermic – protect from thermal changes

Neurological Injuries

• In-flight ConsiderationsElevate headNG/OG to gravity/suctionMonitor for seizure activity – administer

Dilantin prophylaxis, Valium for seizuresHypertension – administer MetoprololHearing protection, eye protection

ACCELERATION/DECELERATION FORCES

POSITIONING THE LITTER PATIENT

DURING TAKE-OFF/ LANDING

Spinal Cord Injuries

• Preflight Assessment

• Diagnosis and treatment

• Level of function

• Airway secured, mech ventilation settings

• Vital signs, POX,

• Foley, NG

• Medications

Spinal Cord Injuries

• Preflight AssessmentIVF and rateSpinal cord immobilization – goal to

preserve current level of function. Avoid logrolling patient

Spring loaded traction

Spinal Cord Injuries

• Stresses of flightALL!

Spinal Cord Injuries

• In-flight ConsiderationMaintain spinal immobilizationMaintain POX 95% or >, EtCO2 30-40

unless concomitant head injury then 25-27Altitude restriction if associated head injuryIVF 80ml/hr NSMonitor vital signs – Neosynephrine for

neurogenic shock? Dopamine?

Spinal Cord Injuries

• In-flight ConsiderationMaintain Methylprednisolone drip if in

progressProtect from hypothermiaProtect from G forces-loss of vasomotor

tone in spinal shock

ACCELERATION/DECELERATION FORCES

POSITIONING THE LITTER PATIENT

DURING TAKE-OFF/ LANDING

Questions????