Preflight Preparation forAir Medical Transport

AIRWAY

  • Maintain Clear Airway (may require oral suctioning, do not exceed 80-100 mmHg)

Provide ventilation and oxygenation if the baby:

  1. requires > 40% oxygen and PaO2 remains < 60 mmHg
  2. PaCO2 > 55 - 65 mmHg with a pH < 7.20
  3. Is apenic or has poor respiratory effort

Guidelines For Determining ETT Size
> 2000 grams = 3.5 ETT
1000 - 2000 grams = 3.0 ETT
< 1000 grams = 2.5 ETT
6 + patient's weight in Kg = lip to tip measurement of ETT (i.e. 1.5 kg baby would require a #3.0 ETT secured 7.5 cm at the lip)

Chest x-ray post intubation

BREATHING

  • Provide supplemental oxygen to maintain oxygen saturation > 85%

CIRCULATION

  • Monitor heart rate and rhythm
  • Perform upper and lower limb blood pressures (to assess for congenital heart defects)
  • Secure two IV sites either peripheral, scalp, or umbilical if time permits and qualified personnel available. (Place small extension tubing on peripheral IVs for easier access when changing over lines)
  • Monitor pre ductal (right hand) and post ductal (any other limb) oxygen saturation if indicated. (i.e. query congenital heart, meconium aspiration, asphyxia or any infant with poor response to oxygen) Important for assessing blood flow and determining pulmonary hypertension.
  • Fluid management - D10W @ 60 cc/kg/day (baby's weight x 60/24 = hourly rate, i.e. a 3 kg baby would receive 7.5 cc/hr)
  • Volume depletion - 10 - 20 mls/kg of normal saline
  • Maintain body temperature between 36.5 - 37.5 degrees Celsius by placing baby in incubator, on an over bed warmer, or covering with warm blankets
  • Maintain blood glucose or chemstrip > 2 mmol/L. A bolus of 2-4 mls/kg of D10W is required for glucose < 2mmol/L followed by an IV infusion of D10W
  • Urine Output - should be > 1cc/kg/hr after 24 hrs of age

Procedures To Consider Or Discuss With The Medical Control Physician

  • Pneumothoraces - Place chest tube prior to flight with any evidence of intrathoracic air on chest x-ray
  • Blood cultures and antibiotics - the usual dose for Ampicillin is 50 mg/kg and for Gentamycin is 2.5 mg/kg
  • Blood work - recent blood gas (arterial or capillary), CBC and differential, glucose and electrolytes
  • Recent x-rays - chest and/or abdomen
  • NPO - the baby should be kept NPO for transport. A nasogastric or orogastric tube will be placed in all intubated infants
  • Foley catheter - consider in all paralyzed and sedated infants

The Transport Team Will Require The Following Prior To Leaving

  • Clotted sample of mother's blood
  • Sample of cord blood
  • A brief transfer note from the attending MD (if possible)
  • Photocopy of patient's chart including the delivery record, maternal history, blood work, x-rays, etc ...

A parent or family member may request to accompany the child during transport.

Many factors influence this decision such as; weight restrictions, number of medical crew, weather conditions, and safety.

Please discuss this issue or any other concerns with the Air Medical Crew.