Neonatal and Pediatric Transport
Neonatal and Pediatric Transport is a complicated and delicate process for clinicians. This short book is intended to help give an overview of critical care transport for the pediatric and neonatal patient.
Core Knowledge edit
Professional Issues edit
Scope of practice of all team members edit
Federal regulations regarding transport edit
EMATALA edit
EMTALA is the Federal Emergency Medical Treatment and Labor Act, also known as COBRA. EMTALA is a statute which governs when and how a patient must be:
- examined and offered treatment or
- transferred from one hospital to another when he is in an unstable medical condition.
EMTALA applies only to "participating hospitals" under Medicare i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients.
- When is a patient considered stabalized?
- (for emergency medical conditions) that no material deterioration of the patient's condition is likely to result from the transfer or is likely to occur during the transfer;
- (for patients in active labor) the infant and the placenta have been delivered.
FAA edit
Informed consent edit
Documentation edit
Transport Environment edit
Environmental Influences edit
Barometric pressure effects edit
Gravitational forces edit
Noise edit
Thermal & humidity effects edit
Vibration edit
Safety edit
Scene safety edit
Evacuation protocols edit
Survival training edit
Disaster planning edit
Crew Stress edit
Environmental edit
Physical edit
Psychological edit
Communication edit
Peer to peer edit
Patient (age appropriate) edit
Parents & family members edit
edit
Cardiopulmonary Arrest (NRP & PALS) edit
Airway edit
Breathing edit
Circulation edit
Thermal Management edit
Hypothermia edit
Hyperthermia edit
Special Skills edit
Intubation edit
Laryngeal mask airway edit
Needle cricothyroidotomy edit
Intravenous /intraosseous Access edit
Insert UVC/UAC edit
Needle aspiration/chest tube insertion edit
Pericardiocentesis edit
Troubleshooting edit
Physical assessment edit
Anatomic abnormalities edit
Developmental/behavioral status edit
Fluid & electrolyte therapy edit
Dehydration edit
Fluid overload edit
Electrolyte abnormalities edit
Infection control issues edit
Principles of mechanical ventilation support during transport edit
Pharmacology edit
Pain management edit
Sedation edit
Physiologic impacts edit
Fluid dynamics edit
Gas changes edit
Laws of science edit
Boyle's Law edit
Charles edit
Dalton's Law edit
The partial pressure of an ideal gas in a mixture is equal to the pressure it would exert if it occupied the same volume alone at the same temperature. This is because ideal gas molecules are so far apart that they don't interfere with each other at all. Actual real-world gases come very close to this ideal.
A consequence of this is that the total pressure of a mixture of ideal gases is equal to the sum of the partial pressures of the individual gases in the mixture as stated by Dalton's law.[1] For example, given an ideal gas mixture of nitrogen (N2), hydrogen (H2) and ammonia (NH3):
where: | |
= total pressure of the gas mixture | |
= partial pressure of nitrogen (N2) | |
= partial pressure of hydrogen (H2) | |
= partial pressure of ammonia (NH3) |
Oxygen consumption edit
Spatial changes edit
Third spacing edit
Neonatal edit
Pulmonary edit
Upper Airway edit
Congenital anomalies edit
Choanal atresia edit
Pierre Robin syndrome edit
Lower Airway edit
Chronic lung disease edit
Parenchymal edit
Aspiration edit
Pneumonia/pneumonitis edit
Respiratory distress syndrome edit
Air leak syndrome edit
Respiratory Failure edit
Cardiovascular edit
Congenital heart conditions edit
Cyanotic edit
Ductal dependent lesions edit
Left to right shunting edit
Persistent pulmonary hypertension of newborn (PPHN) edit
Shock States edit
- Anaphylactic
- Cardiogenic
- Distributive (septic)
- Hypovolemic
Congestive heart failure edit
Pericarditis edit
Dysrhythmias edit
Bradycardia edit
Tachycardia edit
Supraventricular tachycardia (SVT) edit
11.03
Gastrointestinal edit
Necrotizing enterocolitis edit
11.04
Metabolic edit
Hypoglycemia edit
Altered electrolyte balance edit
11.05
CNS/Neurological edit
Seizures edit
Perinatal substance abuse edit
Increased intracranial hemorrhage edit
11.06
Surgical Emergencies edit
Diaphragmatic hernia edit
Gastroschisis edit
Omphalocele edit
Tracheoesophageal fistula edit
11.07
Special Situations edit
-Care of the Extremely Low Birthweight (ELBW) patient in transport