Risk Factors During Transport
Mr. W, a 45-ycar-old man, was involved in a motor vehicle accident when he fell asleep on his way home from work. He was not wearing a seat belt, and there were no air bags in the car. His injuries included chest contusions and broken ribs from the steering wheel and lacerations of his scalp from the windshidd.
‘He was stabilized in the emergency department with the insertion of a chest tube to relieve his left pneumothorax and placement of a pulmonary artery (PA) catheter to monitor for possible cardiac tamponade. He was then admitted to the ICU. Mr. W was assigned to one of the critical care nurses, Nancy, who had two other patients. One of these patients was mechanically ventilated, having undergone repair of an abdominal aortic anelll)1lm the previous day, and the other was recovering from a large anterior myocardial infarction suffered after a total hip replacement.
A chest CT is ordered for Mr. W.
Nancy is aware of the possible complications he might experience during transport: respiratory, cardiovascular, or safety compromises. Possible respiratory complications included upper airway obstruction, respiratory depression, hypoxia, or hypercarbia, especially in a patient who has head and chest trauma and whose oxygenation is already compromised. Cardiovascular risks included hypotension, tachycardia due to cardiac tamponade, and decreased tissue perfusion due to decreased cardiac output and increased tissue oxygen demand during the transfer.
Acute pain may occur or be exacerbated due to increased anxiety, patient movement and positioning, and hard surfaces during transport, as well as potential manipulation/movement of invasive devices such as chest tubes. Anxiety was another potential complication that Nancy considered, both from the activity of transfer and the uncertainty of Mr. W's future.
Anticipating complications, Nancy planned ahead for the transport. She approached the physician to discuss the possibility of intubating and mechanically ventilating Mr. W prior to the transport. With his respiratory status under control, Mr. W could be safely medicated for pain and anxiety, and ultimatdy decrease his oxygen demand. Intubating Mr. W electivdy in the controlled environment of the ICU prevented an emergency situation by eliminating the possible complications of respiratory arrest and emergency intubation.
Which of Mr. W's physiologic systems or clinical states are at particular risk. of compromise during the transport for his CT scan?
How does transporting a patient who is intubated and mechanically ventilated differ from tran1- porting a patient who i1 not intubated?