Critical Care Transport - 3rd Edition
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patient’s physical condition can vary widely from one emergency to another. Nor is it
intended that this textbook shall in any way advise emergency personnel concerning legal
authority to perform the activities or procedures discussed. Such local determination should
be made only with the aid of legal counsel.
23634-7
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Library of Congress Cataloging-in-Publication Data
Names: McEvoy, Mike, editor. | Kivlehan, Sean, editor. | Rabrich, Jeffrey S., editor. |
American Academy of Orthopaedic Surgeons, issuing body.
Title: Critical care transport / edited by American Academy of Orthopaedic Surgeons ; lead
editors, Mike McEvoy, Sean Kivlehan, Jeff Rabrich.
Description: Third edition. | Burlington, MA : Jones & Bartlett Learning, [2023] | Includes
bibliographical references and index.
Identifiers: LCCN 2021043628 | ISBN 9781284236347 (paperback)
Subjects: MESH: Transportation of Patients | Critical Care | Patient Transfer | Emergency
Medical Services
Classification: LCC RA996.5 | NLM WX 215 | DDC 616.02/8--dc23
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6048
Printed in the United States of America
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BRIEF CONTENTS
Acknowledgments
1 Introduction and Overview of Critical Care Transport
2 Medical-Legal Issues
3 Patient Safety
4 Aircraft Fundamentals and Flight Physiology
5 Patient Assessment
6 Respiratory Emergencies and Airway Management
7 Ventilation
8 Critical Care Pharmacology
9 Laboratory Analysis and Diagnostic Studies
10 Resuscitation, Shock, and Blood Products
11 Trauma
12 Neurologic Emergencies
13 Burns
14 Electrophysiology, Pacemakers, and Defibrillators
15 Hemodynamic Monitoring
16 Mechanical Circulatory Support
17 Gastrointestinal and Genitourinary Emergencies
18 Endocrine Emergencies
19 Environmental Emergencies
20 Infectious and Communicable Diseases
21 Toxicologic Emergencies
22 Obstetric and Gynecologic Emergencies
23 Neonatal Emergencies
24 Pediatric Emergencies
25 Bariatric and Special Situations
Glossary
Index
CONTENTS
Acknowledgments
1 Introduction and Overview of Critical Care Transport
Introduction
Critical Care Team Composition and Qualifications
Modes of Transportation
The Transport Process
State and National Standards
Reimbursement
Well-Being
Interpersonal Communication
Quality Assurance and Improvement
The History of CCT
Summary
2 Medical-Legal Issues
Introduction
General Concepts of Liability
Insurance
The Patient’s Right to Decide
Emergency Medical Treatment and Active Labor Act
Health Insurance Portability and Accountability Act
Legal Considerations During Transport Operations
Documentation
Summary
3 Patient Safety
Introduction
History of Quality as a Health Care Discipline
What Is Patient Safety?
Safety Culture
Common Health Care Errors
Why Do Health Care Errors Occur?
Handling Serious Errors
Tools to Identify Errors
Strategies to Avoid Errors
Quality in EMS Settings
Summary
4 Aircraft Fundamentals and Flight Physiology
Introduction
The Air Medical Role
The Atmosphere
Gas Laws
Medical Transport Aircraft
Primary Stressors of Flight
Factors Affecting Tolerance of the Physiologic Stressors of Flight
Hypoxia
Dysbarism and Evolved Gas Disorders
Operational Issues Related to Medical Transport
Air Medical Safety
Making the Industry Safer
Summary
5 Patient Assessment
Introduction
Scene Versus Interfacility Transports
Arrival and Planning
Primary Assessment
Secondary Assessment
Ongoing Assessment
Assembling the Assessed Information
Communications With Receiving Facilities
Summary
6 Respiratory Emergencies and Airway Management
Introduction
Anatomy and Physiology of the Respiratory System
Physiology of the Respiratory System
Patient Assessment
ABG Monitoring
Noninvasive Ventilatory and Oxygenation Monitoring
Respiratory and Ventilation Abnormalities
Basic Airway Management
Advanced Airway Management
Tracheostomy Management
Summary
7 Ventilation
Introduction
Overview of Mechanical Ventilation
Positive-Pressure Ventilators
Ventilator Modes and Parameters
Inhaled Gases
Respiratory Distress and Respiratory Failure
Ventilator Management
Management of Lung Diseases and Conditions
Patient Monitoring
Ongoing Care
Flight Considerations
Basic Ventilator Waveform Analysis
Troubleshooting and Diagnosing Ventilator Problems
Transporting the Patient With a Tracheostomy
Summary
8 Critical Care Pharmacology
Introduction
Pharmacology and Medication Information
A Practical Approach to Medication Administration
Pharmacokinetics
Pharmacodynamics
Avoiding Medication Errors
Medication Management
Specific Medications Used in Critical Care Transport
Medication Infusion Technique
Summary
9 Laboratory Analysis and Diagnostic Studies
Introduction
Principles of Analysis
Specimen Cultures
Chemistry Review
Biochemistry Review
Lab Panels
Blood Gases
Obtaining Blood Samples
Point-of-Care Testing
Urine Lab Values
Diagnostic Imaging
Summary
10 Resuscitation, Shock, and Blood Products
Introduction
Cellular Respiration
Microcirculation and the Cell: Oxygen Transport and Utilization
Shock
Classification of Shock
Sepsis
Blood Administration
Flight Considerations
Summary
11 Trauma
Introduction
Scenarios Involving Trauma Patients
Morbidity and Mortality
Overview of Trauma
Trauma Scoring Systems
Trauma Systems
Interfacility Transport Trauma Management
The Hypothermia–Acidosis–Coagulopathy Triad
Diagnostic Imaging for Trauma
Thoracic Trauma
Pneumothorax
Facial Trauma
Neck Injuries
Abdominal Trauma
Resuscitative Endovascular Balloon Occlusion of the Aorta
Hollow Versus Solid-Organ Injury
Pelvic Trauma
Extremity Trauma
Trauma to Special Populations
Flight Considerations
Summary
12 Neurologic Emergencies
Introduction
Anatomy and Physiology
Neurologic Examination
Traumatic Brain Injury
Specific Neurologic Injuries
Intracranial Pressure
Brain Herniation
Spinal Cord Injuries
Stroke
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Acute Guillain-Barré Syndrome
Seizures and Epilepsy
Transport Considerations
Summary
13 Burns
Introduction
Anatomy and Function of the Skin
Physiology of Burns
Classification of Burn Injuries
Assessment
Management
Special Situations
Summary
14 Electrophysiology, Pacemakers, and Defibrillators
Introduction
Cardiac Anatomy and Physiology
Cardiac Monitoring: 12-Lead ECG
Axis Determination
Bundle Branch Blocks and Hemiblocks
Selected ECG Findings
Cardiac Disease
Cardiac Electrophysiology
Transport Considerations
Summary
15 Hemodynamic Monitoring
Introduction
Cardiovascular Anatomy and Physiology
Arterial Lines
Central Venous Lines
Pulmonary Artery Catheters
Invasive Pressure Measurements
Heart Failure
Shock
Flight Considerations
Summary
16 Mechanical Circulatory Support
Introduction
Intra-aortic Balloon Pump
Extracorporeal Membrane Oxygenation
Microaxial Catheter Pump Systems
Implantable Left Ventricular Assist Devices
Summary
17 Gastrointestinal and Genitourinary Emergencies
Introduction
Anatomy and Physiology
Conditions Affecting the Alimentary Canal
Intestinal Obstructions
Liver Disease
Biliary Tract Obstructions
Pancreatic Disease
Urinary System Conditions
Maintenance Tubes
Metabolic Regulation of Acid–Base Status
Flight Considerations
Summary
18 Endocrine Emergencies
Introduction
Anatomy and Physiology
Diabetes
Pituitary Disorders
Adrenal Abnormalities
Thyroid Abnormalities
Lipid Disorders
Flight Considerations
Summary
19 Environmental Emergencies
Introduction
Heat Emergencies
Cold Emergencies
Drowning
Diving Injuries and Decompression Sickness
Altitude Illness
Summary
20 Infectious and Communicable Diseases
Introduction
Fundamental Principles of Infectious Disease
The Human Immune System
Pathogenicity
Epidemiology
Selected Diseases
Emerging Infectious Diseases
Strategies for the Treatment of Infectious Disease
The Post-Antibiotic Era
Bioterrorism
Exposure and Protection
Flight Considerations
Summary
21 Toxicologic Emergencies
Introduction
General Toxicologic Emergency Management
Toxic Syndromes and Medication Reaction Syndromes
Decontamination
Specific Toxicologic Emergencies
Hazardous Materials Response
Radiation Emergencies
Flight Considerations
Summary
22 Obstetric and Gynecologic Emergencies
Introduction
Anatomy and Physiology of the Female Reproductive System
Physiologic Changes During Pregnancy
Critical Care Transport of the Pregnant Patient
Fetal Assessment and Monitoring
Complications of Pregnancy
Medical Conditions During Pregnancy
Complications During Labor
Delivery
Postdelivery Complications
Gynecologic Emergencies
Gynecologic Trauma
Summary
23 Neonatal Emergencies
Introduction
Anatomy and Physiology of a Neonate
Neonatal Assessment and Stabilization
Neonatal Resuscitation
Respiratory Conditions
Cardiovascular Conditions
Gastrointestinal Conditions
Infectious Diseases/Sepsis
Hyperthermia/Hypothermia
Toxic Exposure
Trauma/Birth Injuries
Neurologic Conditions
Metabolic Conditions
The Transfer Process for a Neonate
Flight Considerations
Summary
24 Pediatric Emergencies
Introduction
Anatomy and Physiology
Growth and Development
Approach to Parents and Caregivers
Pediatric Assessment
Transport Considerations
Airway Management Devices
Respiratory Conditions
Mechanical Ventilation
Cardiac Conditions
Cardiac Anomalies
Renal Conditions
Meningitis
Trauma
Abuse and Neglect
Hypothermia During Transport
Drowning
Flight Considerations
Summary
25 Bariatric and Special Situations
Introduction
Bariatric Patients
Excited Delirium
Children With Special Health Care Needs
Summary
Glossary
Index
