# Stabilizing a Trauma Patient Beyond the "Golden Hour"



## VentMedic (Aug 27, 2008)

*These are for those of you who have asked questions about CCT, Flight, MAP, ABGs, terms Rid and I have used or who don't know what all goes into stabilizing a patient for a transport from a smaller hospital to a trauma center:*



*Stabilizing a Trauma Patient Beyond the "Golden Hour"*

By Paul Mazurek

http://www.ems1.com/Columnists/paul...izing-a-Trauma-Patient-Beyond-the-Golden-Hour



> An air medical transport team is called to the intensive care unit of a local referring center for a 27-year-old male brought to the emergency department after a high-speed rollover motor vehicle crash. The patient sustained a closed head injury and an open-book pelvic fracture. The crash occurred two hours prior to the team’s arrival at the referring center. He is still in spinal precautions, intubated, and has a pelvic binder in place.
> 
> Prior to the crew’s arrival on the unit, the patient had received four units of type-specific packed red blood cells (PRBCs) and six liters of crystalloid. He is restless and fighting mechanical ventilation. Blood pressure is 100/56. The monitor is showing a sinus rhythm at 104 beats per minute. Peripheral pulses are palpable and the patient’s skin is warm, dry and pale. His oxygen saturation is 96 percent on 1.0 fiO2. There is approximately 100 ml of amber urine in the patient’s urimeter.
> 
> ...


 
*For the answers to the questions and explanations:*
http://www.ems1.com/Columnists/paul...izing-a-Trauma-Patient-Beyond-the-Golden-Hour

*Keep in mind that the above is just an overview of things to consider for transport. *

Another good article by this author:
*Transport Management for the Sepsis Patient*



> Your transport team is called to the intensive care unit of a 68-bed community hospital 30 nautical miles away for a 64 year-old male admitted three days ago with “flu-like” symptoms. The patient had been admitted to the hospital by his primary care provider for general malaise, a temperature of 100.9F and a high white blood cell count.
> 
> Sputum cultures were positive for gram-negative rods and appropriate oral antimicrobial coverage had been initiated. Early this morning, the patient experienced increased dyspnea, weakness and confusion. He was transferred to the ICU for further work up.
> 
> ...


 
*Read more for answers and explanations at:*
http://www.ems1.com/columnists/paul...2-Transport-Management-for-the-Sepsis-Patient

*An Emergency of the Aortic Kind*

http://www.ems1.com/columnists/paul-mazurek/articles/400977-An-Emergency-of-the-Aortic-Kind
*Air Transport Case of the Month*



> You are called to the emergency room of a community hospital to transport a 57-year-old male with a 12-hour history of chest pain. The patient is to be delivered directly to the cardiac catheterization lab of an academic medical center 50 miles away.
> 
> He has received a 12-lead EKG and portable chest x-ray. Initial laboratory studies have been drawn and sent. The bedside nurse reports that the patient has received chewable aspirin, three sublingual nitroglycerin tablets with minimal relief, a total of 5mg of morphine sulfate IV and the first of three 5mg IV metoprolol doses. Heparin and nitroglycerin infusions have been prepared but not yet started. A dose Retavase (Reteplase), 10 units IV have also been ordered but not yet administered.
> 
> ...


 
*Read more for answers and explanations at:*
http://www.ems1.com/columnists/paul-mazurek/articles/400977-An-Emergency-of-the-Aortic-Kind

*These scenarios are just to get one to think about how important it is to have a solid foundation established in your education and to continue to advance your knowledge. Somethings shouldn't be memorized but rather they should be understood. The scenarios are also to introduce one into the vast world of critical care medicine. *


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## Airwaygoddess (Aug 27, 2008)

*To understand and learn.....*

These are very great posts Vent!!


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## Ridryder911 (Aug 27, 2008)

EEEK ... I am having flash backs of the CFRN and FP-C tests questions!...........


R/r 911


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## fma08 (Aug 28, 2008)

Can't thank you enough for this post, very insightful.


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## rhan101277 (Aug 28, 2008)

These are tough, out of my skill range.  Let me go back under my rock.

I didn't realize that some transports can be this complicated.


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## VentMedic (Aug 28, 2008)

It gives you a different insight on transport medicine and why some of us are big advocates of EDUCATION and not just meeting the minimum amount of "training hours" as required by your state.


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## mycrofft (Aug 29, 2008)

*Thanks, it's always good to read stuff over my depth.*

Yes, we always need to press on, and it's incumbent upon the younger folks to press ever further as they amass a body of practical experience.


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