TRANSFER OF A CRITICALLY ILL MOTHER BY DR SHASHWAT JANI

Dr. Shashwat Jani.
M. S. ( Obs – Gyn ), F.I.A.O.G.
Diploma in Advance Laparoscopy.
Consultant Assistant Professor,
Smt. N.H.L. Municipal Medical College.
Sheth V. S. General Hospital , Ahmedabad.
Mobile : +91 99099 44160.
E-mail : drshashwatjani@gmail.com

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Dr Shashwat Jani.
+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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Dr Shashwat Jani.
+91 99099 44160.
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+91 99099 44160.
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Dr Shashwat Jani.
+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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+91 99099 44160.
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Delay in transfer…
In settings where maternal mortality is highest,
3 crucial delays are directly associated with elevated rates
of maternal mortality.
(1) delay in seeking health care,
(2) delay in reaching a health facility,
(3) delay in obtaining appropriate care upon reaching a
health facility.
To improve obstetric outcomes, a woman must
recognize that she is experiencing an obstetric emergency,
her family must be supportive of her seeking care at a
health facility, she must be able to access transportation
and be successfully transported to the appropriate health
facility, and she must receive the care that she needs.
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Why Do Pregnant Women Become
Critically Ill?
09-Jul-18
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+91 99099 44160.
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Critically Ill Mother
Pregnant women can become critically ill due
to a wide range of conditions, and these can be
divided into four main groups:
1) Specific to pregnancy: e.g.
• pre-eclampsia, acute fatty liver,
• obstetric haemorrhage, amniotic fluid
embolus, and peripartum cardiomyopathy.
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2 ) Increased susceptibility in pregnancy: e.g. venous
thromboembolism, aspiration syndromes.
3 ) Underlying medical condition that is exacerbated
by pregnancy: e.g.
• congenital heart disease,
• pulmonary hypertension, and
• chronic renal failure.
4 ) Unrelated to pregnancy and coincidently
developed during pregnancy: e.g.
• diabetic ketoacidosis,
• pneumonia, and
• asthma.
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+91 99099 44160.
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Transfer…
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Types of Transfer
• Intrahospital--transport of a patient from
one location to another within the hospital
• Interhospital--transport of a patient
between hospitals
• Scene run--transport of a patient from a
non-medical site to the nearest available
or designated hospital
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• Transfer of any sick patient
either within the hospital or
between hospitals is potentially
hazardous.
• Careful multidisciplinary co-
ordination to ensure the
necessary resources is essential
to reduce the hazards .
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Dr Shashwat Jani.
+91 99099 44160.
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Different
Indications
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Critically ill Antenatal or Postnatal transfer to
Tertiary care hospital.
In-utero transfer from PHC to another hospital .
Homebirth transfer from home to hospital .
Postnatal transfer of mother to another hospital.
Postnatal transfer of mother to X-ray department
for embolisation .
Transfer of mother to ICU or another ward within
the hospital – either antenatal or postnatal.
Neonatal transfer to a specialist unit .
Transfer of women in labour from Pre labour room
to Labour room.09-Jul-18
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Critically ill Obstetric patients are at increased risk of
morbidity and mortality during transport .
Risk can be minimized and outcomes
improved with :
1. Careful planning & Communication
2. Appropriately qualified personnel
3. Availability of appropriate equipment &
Drugs
4. Monitoring
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Pre transport
Communication
When an alternate team at a receiving
location will assume responsibility for the
patient after arrival, continuity of patient
care will be ensured by physician to
physician and nurse-to-nurse
communication to review patient condition
and the treatment plan.
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Dr Shashwat Jani.
+91 99099 44160.
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Pretransport Stabilization
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Ensure the patient is stabilized as
best as possible prior to transfer.
Hasty Transfer Of An
Unstable Patient May Cause
More Harm.
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Modes Of Transport
The following needs to be considered when
deciding on the best mode of transportation
a) Urgency of transfer
b) Condition of the patient
c) Availability of ambulance/ other mode of
transport
d) Distance and estimated transit time
e) Time of day & weather
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+91 99099 44160.
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Road Transport
• Distance from the referring centre to tertiary
hospital
• Condition of road
• Availability of transport- ambulance or 4WD
• Weather
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+91 99099 44160.
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Air Transport
Considerations include:
• Severity of the cases
• Availability of the helicopter
• Weather

• Local Knowledge is essential …!!!
• MO / paramedical staffs posted
to remote clinics or PHCs should
learn about the area where they
are serving & find ways of quickly
& safely transporting their
patients.
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Accompanying Personnel
It is strongly recommended that a critically ill
mother should be accompanied by …
 1 senior & 1 junior obstetrician ( atleast 1 )
1 critical care specialist
1 trained Nurse.
Obstetrician & Nurse should be trained in ACLS
& BLS .
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Dr Shashwat Jani.
+91 99099 44160.
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Accompanying Equipments &
Drugs
• BP monitor, pulse oximeter, monitor/defibrillator
accompany every patient without exception.
• When available, a memory-capable monitor with
the capacity for storing and reproducing patient
data will allow review of data collected during the
procedure, and transport.
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+91 99099 44160.
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• Equipment for airway management, sized
appropriately for each patient, is also
transported with each patient, as is an
oxygen source of ample supply to provide for
projected needs plus a 30-min reserve.
• NG tube is inserted to avoid aspiration
during transfer
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Dr Shashwat Jani.
+91 99099 44160.
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Basic resuscitation drugs, including
epinephrine and antiarrhythmic agents are
transported with each patient in the event of
sudden cardiac arrest or arrhythmia.
A more complete array of pharmacologic
agents CRASH CART ( all essential emergency
drugs ) should be there.
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+91 99099 44160.
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• Ensure the ambulance or transport have the
required resuscitative equipments that is in
good working order ( availability of oxygen
tank)
• Ensure the staff escorting the patient knows
how to operate the resuscitative equipments.
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Dr Shashwat Jani.
+91 99099 44160.
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• Ensure the appropriate medications
(eg:MgSO4, Oxytocin , parenteral anti-HPT,
sedatives, muscle relaxants) which are needed
should be prepared in prefilled syringes
• Crossmatch blood products to bring along if
indicated.
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+91 99099 44160. 37

ECLAMPSIA KIT
9 July 2018 38Dr Shashwat Jani. 99099 44160.

PPH KIT
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+91 99099 44160.
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VAGINAL DELIVERY KIT
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+91 99099 44160.
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NEONATAL RESUSCITATION KIT
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+91 99099 44160.
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Monitoring During Transport
• All critically ill patients undergoing transport
receive the same level of basic physiologic
monitoring during transport as they had in the
ICU.
• This includes, at a minimum, continuous ECG
monitoring, continuous pulse oximetry and
periodic measurement of blood pressure,
pulse rate, and respiratory rate.
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+91 99099 44160.
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• In addition, selected patients may benefit
from capnography, continuous intra-arterial
blood pressure, pulmonary artery pressure, or
intracranial pressure monitoring.
• Fetal Monitoring.
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+91 99099 44160.
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• In addition, selected patients may benefit
from capnography, continuous intra-arterial
blood pressure, pulmonary artery pressure, or
intracranial pressure monitoring.
• Fetal Monitoring.
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
43

Adverse Effects
Adverse events during transport of
critically ill patients fall into two general
categories:
1. Mishaps related to intensive care (e.g., lead
disconnections, loss of battery power, loss of
intravenous access, accidental extubation, occlusion
of the endotracheal tube, or exhaustion of O2
supply.
2. Physiologic deteriorations related to critical
illness (e.g., worsening hypotension or hypoxemia.
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Dr Shashwat Jani.
+91 99099 44160.
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Handing Over…
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+91 99099 44160.
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Handing Over
This should be done systematically
throughout all levels…
- Escorting MO - Referral centre MO/
Specialist
- Escorting SN/ MA - Referral centre SN
• Proper communication & documentation
is vital.
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Dr Shashwat Jani.
+91 99099 44160.
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Documentation
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Documentation
The clinical record should have the following
documentation:
a) Patient’s clinical status before, during and after
transport.
b) Relevant medical conditions
c) Therapy given
d) Any other pertinent events or conditions
A copy of this record should be provided to the
receiving facility.
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Transfer slip
09-Jul-18
Dr Shashwat Jani.
+91 99099 44160.
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Transport Team Responsibilities Stabilization
Phase
• Quick assessment of patient status
• Stabilization of patient for transport
• Anticipation of problems likely encountered on
transport
• Secure all lines and tubes
• Communication with receiving physician/nurse
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09-Jul-18 51
Dr Shashwat Jani.
+91 99099 44160.

TRANSFER OF A CRITICALLY ILL MOTHER BY DR SHASHWAT JANI

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