When at all practicable, the head and/or upper body of the patient should be elevated via ramping (a folded blanket stack) or by raising the head of the transport bed, ideally to a 30-degree angle. This increases the period of safe apnea (the amount of time until a patient reaches an oxygen saturation level of 88% to 90%), lowers the burden of the patient's breathing, and improves patency of the upper airway. Confounding factors, such as severe weather, may call for the patient to be transported in a supine position to ensure patient safety, but doing so puts them at risk for a decline in functional reserve capacity, a drop in tidal volume, an elevation of the gastric bubble above the cardiac sphincter, and a drop in preload, all of which could worsen their overall condition. In a supine position, the lung capacity is reduced by around 50%.
Patients with acute pancreatitis often complain of severe upper left quadrant pain, which is exacerbated when the patient moves into a recumbent position or has severe pain in the epigastric region. Vasodilation of the pancreatic vasculature or leaking of the pancreatic capillary bed may contribute to the sequestration of up to 6 liters of fluid in the retroperitoneal area. Medical transport teams must ensure aggressive fluid resuscitation for these patients to overcome the hypovolemia resulting from fluid sequestration. In addition, oxygenation, hemodynamic stability, and pain management are critical components of transporting these patients.
Pediatric-aged patients between the ages of 8 to 15 years are at greatest risk of spinal cord injury (SCI) with subaxial vertebral body fractures affecting the C3 to C7 level of the spine as a result of injuries sustained during sports activities, falls, diving accidents, and motor vehicle crashes. An SCI to the C3-C4 level occurs during trauma when the head is bent forward and the spinal cord is compressed at great force when the head is driven into an object in front of it. Fracture of the vertebral body is typically followed by spinal cord edema, resulting in life-threatening disability. A C3-C4 SCI may result in the injured patient being unable to breathe on his own, and with full loss of motor and sensory functions of both his upper and lower extremities, but with the ability to move his head and speak. The C3-C4 spinal cord injured patient will most likely require full care with all activities and functions of daily life for the rest of his life.
The initial step in treating patients who have suffered serious limb injuries that have resulted in bleeding should be the rapid application of strong direct pressure in the management of compressible extremities hemorrhage. If continuous direct pressure can be administered and sustained by the transport provider, bleeding can typically be stopped in parts of the body that can be easily compressed—the extremities and scalp. The transport provider should make sure they are exerting pressure properly if this intervention doesn't help to quickly reduce or stop the bleeding. applied direct pressure
The six extraocular muscles linked to each eye allow the typical patient to move their eyes through the six cardinal orientations of gazing. Cranial nerves III, IV, and VI supply energy to the extraocular muscles. The superior oblique muscle is regulated by cranial nerve IV, the lateral rectus muscle is controlled by cranial nerve VI, and the other extraocular muscles are controlled by cranial nerve III. Restriction interrupted or diminished innervation, or trauma can all impede extraocular movement. Thyroid orbitopathy, myositis, and mechanical muscle entrapment due to an orbital blow-out fracture are a few examples of limitations. Stroke, myasthenia gravis, diabetes, hypertension, tumors, aneurysms, infections, and trauma can all result in cranial nerve paresis or palsies.
The leading cause of death in burn patients is inhalation injuries, which also significantly contribute to overall morbidity and mortality in these people. Asphyxia brought on by carbon monoxide poisoning, heat injuries (mainly to the supraglottic area), and chemical injuries (primarily to the supraglottic region) are the categories under which inhalation injuries fall. Any patient with burns on their face, neck, or head should be suspected of having an inhalation injury. Even in patients who initially don't seem to have one, this possibility should be closely watched, as inhalation injury may not be detected until after the patient has received fluid resuscitation, which corrects the initial "dehydrated" state of the burned tissues.
When practical, a chest x-ray should be used to check proper ETT implantation. The third and fourth thoracic vertebrae should be level with the distal tip of the ETT, which should be positioned 4 to 5 cm above the carina. Visualizing Murphy's eye, the vent hole on the side of the ETT near the intersection of the clavicle bones, helps rapidly verify proper installation.
