solved

Question
Answered step-by-step
Asked by lightuptheworld11

You are called to a local hospital for an interfacility transport of a 34 year old male post code and is Covid positive. You receive report that the patient was on his way to dialysis four hours prior when he collapsed in the parking lot of his dialysis center. This was a witnessed arrest by his wife. EMS initiated CPR who was found to be in V-Fib and defibrillated twice, two rounds of Epinephrine were given and ROSC was achieved after care was turned over to hospital staff. Post arrest rhythm is a sinus rhythm with peaked T waves and right bundle branch block. Hospital staff treated the patient for hyperkalemia with D50, Insulin and sodium bicarbonate. Per the wife, the patient has been sick for the last week with generalized weakness and a general complaint of “not feeling well”, and has been Covid positive for a week now. The patient is needing admit to an ICU, as the sending hospital has no available beds within its intensive care unit.

 

Upon arrival at bedside, the patient is intubated and ventilated on a volume control mechanical ventilator setting (AC 17, Vt 550, PEEP 5, FiO2 0.9). For IV access, you have an IO to the right lower leg, 20g IV to the right forearm, 20g IV to the right hand and a left femoral triple lumen central line. A foley catheter is in place with no urine output noted.  Currently the patient is on a Fentanyl and Versed infusion. Transport time of 45 minutes via helicopter.

 

Your assessment reveals the following:

 

Airway/Breathing: secured with 7.5 ETT on mechanical ventilator. Pt is over breathing the vent at a rate of 34.

 

Circulation: Pulses present to all extremities, skin is normal, cool and dry.

 

Disability: GCS 1/1/1, pupils are bilaterally 3mm and sluggish to respond, Glucose of 82

 

Exposure: Pt had cooling measures initiated and measured a core body temperature of 32.3 degrees celsius. Fistula to the left forearm. You notice the skin to the bilateral posterior legs is burned due to the collapse in the parking lot on hot asphalt.

 

Labs:                                                                 Vitals:

            Na: 134                                                            BP: 113/80 (91)

            K: 8.5                                                                SpO2: 100%

            Cl: 94                                                                HR: 77 Sinus Rhythm

            CO2: 12                                                            Resp: 33

            BUN: 113                                                          EtCO2: 27

            Creat: 12.39

            Lactate: 13.4

 

ABG:

            pH: 6.8

            pCO2: 32.4

            pO2: 183

            HCO3: 5.3

            BE: -27.9

 

What preparations do you need to have in place for your transport? (PPE, equipment, fuel, weather, etc)

What are your concerns for your transport?

Any additional assessments you would like to perform?

Any additional interventions you would like to perform/change?

What gas laws would you need to consider that could affect your patient flight?

What would you prioritize to do on scene at bedside and what would you manage in air during transport?

SCIENCE
HEALTH SCIENCE
NURSING
EMD 410